Korean J Transplant.  2022 Nov;36(Supple 1):S201. 10.4285/ATW2022.F-3361.

Liver transplantation in high acuity recipients: a single center analysis of outcomes and factor predicting futile transplantation

• Srimanoroth T
• Dumronggittigule W
• Kositamongkol P
• Sirivatanauksorn Y
• Limsrichamrern S
• Mahawithitwong P
• Tovikkai C
• Sangserestid P
• Assawasirisin C

• KMID: 2535266
• DOI: http://doi.org/10.4285/ATW2022.F-3361

Abstract

Background
Although life-saving benefit of liver transplantation (LT) is evident in end-stage liver disease patients, the futility rate is concerned among high acuity recipients, acute liver failure (ALF) and acute on chronic liver failure (ACLF), due to the possibility of too sick to transplant condition. To predict patients who are unlikely to be futile LT would be advantage to select suitable candidates. The study aimed to evaluate LT outcomes for recipients with ALF or ACLF who needed an urgent-in-hospital evaluation and to identify factor predicting futility.
Methods
An analysis included patients who underwent urgent LT for ALF/ACLF in Siriraj Hospital, 2002–2021. The Kaplan-Mei-er survival analysis and the binary logistic regression analysis were performed to identify factors associated with futility which was defined as same admission death (SAD) or totally dependent status (TDS) after LT.
Results
Sixty-nine recipients (ALF, 23.2% ; ACLF, 76.8%) were enrolled. The 5-year survival rate was 73.1% for ALF and 79.3% for ACLF. There were 15 (21.7%) futile LT (eight SAD and seven TDS). The univariate analysis revealed four possible pretransplant predictors of futility including vasopressor support (P=0.010), abnormal chest film (CXR; P=0.011) suggesting lung infection, renal replacement therapy (RRT; P=0.106), and positive hemoculture (P=0.185). The multivariate analysis identified two inde-pendent predictors of futility, vasopressor support and abnormal CXR (P=0.036 and P=0.037). Moreover, recipient with four aforementioned predictors experienced 100% futility while recipient with three predictors experienced 83% futility. Additionally, recipients who needed vasopressor support with abnormal CXR were associated with 75% futility.
Conclusions
Long-term survival of patients with ALF/ACLF following LT is acceptable. To avoid too sick to transplant recipients is the key to prevent futile LT. Our study recommended to deny LT for patients with combination of the conditions including vasopressor support, abnormal CXR, positive hemoculture, and RRT.