Outcome of patients with acute liver failure awaiting liver transplantation in Japan

Takuya Genda; Takafumi Ichida; Shotaro Sakisaka; Eiji Tanaka; Satoshi Mochida; Yoshiyuki Ueno; Ayano Inui; Hiroto Egawa; Koji Umeshita; Hiroyuki Furukawa; Seiji Kawasaki; Yukihiro Inomata

doi:10.1111/hepr.13549

Outcome of patients with acute liver failure awaiting liver transplantation in Japan

Hepatol Res. 2020 Oct;50(10):1186-1195. doi: 10.1111/hepr.13549. Epub 2020 Aug 11.

Authors

Takuya Genda^{1

2}, Takafumi Ichida^{3

2}, Shotaro Sakisaka^{4

2}, Eiji Tanaka^{5

2}, Satoshi Mochida^{6

2}, Yoshiyuki Ueno^{7

2}, Ayano Inui^{8

2}, Hiroto Egawa^{9

2}, Koji Umeshita^{10

2}, Hiroyuki Furukawa^{11

2}, Seiji Kawasaki^{12

2}, Yukihiro Inomata^{13

2}

Affiliations

¹ Department of Gastroenterology and Hepatology, Juntendo University Shizuoka Hospital, Izunokuni, Japan.
² The Assessment Committee of Indication for Transplantation.
³ Department of Hepatology, East Shonan General Hospital, Kanagawa, Japan.
⁴ Department of Gastroenterology, Faculty of Medicine, Fukuoka University, Fukuoka, Japan.
⁵ Department for the Promotion of Regional Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
⁶ Department of Gastroenterology and Hepatology, Saitama Medical University, Saitama, Japan.
⁷ Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan.
⁸ Department of Pediatric Hepatology and Gastroenterology, Saiseikai Yokohamashi Tobu Hospital, Kanagawa, Japan.
⁹ Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁰ Division of Health Science, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹¹ Department of Gastroentrologic and General Surgery, Asahikawa Medical University, Asahikawa, Japan.
¹² Department of Surgery, Mitsui Memorial Hospital, Tokyo, Japan.
¹³ Department of Pediatric Surgery and Transplantation, Kumamoto Rosai Hospital, Kumamoto, Japan.

PMID: 32720378
DOI: 10.1111/hepr.13549

Abstract

Aim: To clarify the outcome and predictive factors in patients with acute liver failure (ALF) awaiting deceased donor liver transplantation (DDLT) in Japan.

Methods: Of the DDLT candidates in Japan between 2007 and 2016, 264 adult patients with ALF were retrospectively enrolled in this study. Factors associated with DDLT and waiting-list mortality were assessed using the Cox proportional hazard model. The DDLT and transplant-free survival probabilities were evaluated using Kaplan-Meier analysis and the log-rank test.

Results: The waiting-list registration year after the Transplant Law revision in 2010 was a significant factor associated with DDLT. The adjusted hazard ratio indicated that DDLT probability after 2010 was four times higher than that before, and the 28-day cumulative DDLT probability was more than 35%. The median survival time of the entire cohort was 40 days. Multivariate analysis identified the following three factors associated with waiting-list mortality: age, coma grade, and international normalized ratio. The transplant-free survival probabilities were significantly stratified by the number of risks, and patients with all three risks showed extremely poor short-term prognosis (median survival time = 23 days).

Conclusions: The DDLT probability of ALF patients increased after the law revision in 2010; however, patients at high risk of short-term waiting-list mortality might need emergent living donor transplantation.

Keywords: donor; prognosis; registration; risk factor; survival.