TY - JOUR
T1 - Liver transplantation for acute liver failure in Europe
T2 - outcomes over 20 years from the ELTR database
AU - Germani, Giacomo
AU - Theocharidou, Eleni
AU - Adam, Renè
AU - Karam, Vincent
AU - Wendon, Julia
AU - O'Grady, John
AU - Burra, Patrizia
AU - Senzolo, Marco
AU - Mirza, Darius
AU - Castaing, Denis
AU - Klempnauer, Jurgen
AU - Pollard, Stephen
AU - Paul, Andreas
AU - Belghiti, Jacques
AU - Tsochatzis, Emmanuel
AU - Burroughs, Andrew K
N1 - Copyright © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
PY - 2012/8
Y1 - 2012/8
N2 - BACKGROUND & AIMS: Liver transplantation for acute liver failure (ALF) still has a high early mortality. We evaluated changes during 20 years, and identified risk factors for poor outcome.METHODS: Donor, graft, and recipient variables from the European Liver Transplant Registry database (January 1988-June 2009), were analysed. Aetiologies and time periods were compared. Three and 12-month survival models were generated from separate training data sets, which were validated. A sub-analysis was performed for recipient older than 50 years.RESULTS: Four thousand nine hundred and three patients were evaluated. One, 5- and 10-year patient, and graft survival rates were 74%, 68%, 63%, and 63%, 57%, 50%, respectively. Survival was better in 2004-2009 compared to previous quinquennia (p<0.001), despite donors >60 years increased from 1.8% to 21%. A higher incidence of suicide or non-adherence occurred in paracetamol-related ALF (p<0.001). Death or graft loss were independently associated with male recipients (adjusted OR 1.25), recipient >50 years (1.26), incompatible ABO matching (1.93), donors >60 years (1.21), and reduced size graft (1.54). For both 3- and 12-month models, incompatible ABO matching, non-viral aetiology, reduced size graft, and non-UW preservation fluid were associated with increased mortality/graft loss, whereas male recipients and age >50 years were associated only at 12 months. Both models had reasonable discriminative ability with good calibration at 3 months. Recipients >50 years, combined with donors >60 years resulted in 57% mortality/graft loss within the first year.CONCLUSIONS: Survival after liver transplantation has improved despite increases in donor/recipient age. Recipients >50 years paired with donors >60 years had a very high mortality/graft loss within the first year.
AB - BACKGROUND & AIMS: Liver transplantation for acute liver failure (ALF) still has a high early mortality. We evaluated changes during 20 years, and identified risk factors for poor outcome.METHODS: Donor, graft, and recipient variables from the European Liver Transplant Registry database (January 1988-June 2009), were analysed. Aetiologies and time periods were compared. Three and 12-month survival models were generated from separate training data sets, which were validated. A sub-analysis was performed for recipient older than 50 years.RESULTS: Four thousand nine hundred and three patients were evaluated. One, 5- and 10-year patient, and graft survival rates were 74%, 68%, 63%, and 63%, 57%, 50%, respectively. Survival was better in 2004-2009 compared to previous quinquennia (p<0.001), despite donors >60 years increased from 1.8% to 21%. A higher incidence of suicide or non-adherence occurred in paracetamol-related ALF (p<0.001). Death or graft loss were independently associated with male recipients (adjusted OR 1.25), recipient >50 years (1.26), incompatible ABO matching (1.93), donors >60 years (1.21), and reduced size graft (1.54). For both 3- and 12-month models, incompatible ABO matching, non-viral aetiology, reduced size graft, and non-UW preservation fluid were associated with increased mortality/graft loss, whereas male recipients and age >50 years were associated only at 12 months. Both models had reasonable discriminative ability with good calibration at 3 months. Recipients >50 years, combined with donors >60 years resulted in 57% mortality/graft loss within the first year.CONCLUSIONS: Survival after liver transplantation has improved despite increases in donor/recipient age. Recipients >50 years paired with donors >60 years had a very high mortality/graft loss within the first year.
KW - Adult
KW - Databases, Factual
KW - Europe
KW - Female
KW - Humans
KW - Liver Failure, Acute
KW - Liver Transplantation
KW - Male
KW - Middle Aged
KW - Proportional Hazards Models
KW - Time Factors
KW - Tissue Donors
KW - Treatment Outcome
U2 - 10.1016/j.jhep.2012.03.017
DO - 10.1016/j.jhep.2012.03.017
M3 - Article
C2 - 22521347
SN - 0168-8278
VL - 57
SP - 288
EP - 296
JO - Journal of Hepatology
JF - Journal of Hepatology
IS - 2
ER -