Survival with and without liver transplantation in critically ill patients with cirrhosis: a twenty-year experience

TY - JOUR

T1 - Survival with and without liver transplantation in critically ill patients with cirrhosis

T2 - a twenty-year experience

AU - Bernal, William

AU - Bittermann, Therese

AU - Sheth, Roosey

AU - Trovato, Francesca

AU - McPhail, Mark J

AU - Khan, Pervez

AU - Calvert, Stacey

AU - Pirani, Tasneem

AU - Patel, Sameer

AU - Loveridge, Robert

AU - Willars, Christopher

AU - Auzinger, Georg

AU - Wendon, Julia A

N1 - Copyright © 2025. Published by Elsevier Inc.

PY - 2025/6/3

Y1 - 2025/6/3

N2 - BACKGROUND & AIMS: In 2015 we reported the outcome of patients with cirrhotic chronic liver disease (CLD) with unplanned admission to a specialist single-centre Liver Intensive Therapy Unit (LITU) demonstrating progressive improvement in short-term survival. We investigated if this and long-term survival had continued to improve, and its relation to use and outcome of liver transplantation (LT).METHODS: A retrospective cohort study of consecutive adult patients with cirrhosis and unplanned emergent first LITU admission 01/2000-03/2020. Demographic and clinical variables were obtained at admission; ACLF grade was categorized as 0 (no ACLF), 1-2 or 3. Transplant-free survival (TFS) and LT practices were characterized and survival compared using time-to-event analysis.RESULTS: The cohort comprised 1,688 patients, 62% male, median age 52 (IQR 43-60) years with MELD score 28 (18-37); 23% had no ACLF, 39% ACLF-1-2 and 37% ACLF-3; TFS closely related to ACLF grade (p<0.001). LITU TFS was 51.9% in 2000-09, increasing to 70.6% in 2010-20 (p<0.001); improvement for ACLF-3 was smaller: 31.0% to 45.8%, (p<0.001). There was no difference in TFS survival in 2010-14 vs. 2015-20. Long-term TFS was poor with <20% of patients alive without LT 1-year after LITU admission. During follow-up 280 underwent LT: the proportion transplanted increased from 12.6% in 2000-09 to 20.2% in 2010-20, with 1- and 5-year post-transplant survival of 91% and 81.9%.CONCLUSIONS: TFS has now plateaued with need for novel interventions to improve survival in ACLF. Liver transplantation is infrequently utilised but has excellent outcomes. ACLF survivors should be closely followed up with strong consideration given for transplant assessment.

AB - BACKGROUND & AIMS: In 2015 we reported the outcome of patients with cirrhotic chronic liver disease (CLD) with unplanned admission to a specialist single-centre Liver Intensive Therapy Unit (LITU) demonstrating progressive improvement in short-term survival. We investigated if this and long-term survival had continued to improve, and its relation to use and outcome of liver transplantation (LT).METHODS: A retrospective cohort study of consecutive adult patients with cirrhosis and unplanned emergent first LITU admission 01/2000-03/2020. Demographic and clinical variables were obtained at admission; ACLF grade was categorized as 0 (no ACLF), 1-2 or 3. Transplant-free survival (TFS) and LT practices were characterized and survival compared using time-to-event analysis.RESULTS: The cohort comprised 1,688 patients, 62% male, median age 52 (IQR 43-60) years with MELD score 28 (18-37); 23% had no ACLF, 39% ACLF-1-2 and 37% ACLF-3; TFS closely related to ACLF grade (p<0.001). LITU TFS was 51.9% in 2000-09, increasing to 70.6% in 2010-20 (p<0.001); improvement for ACLF-3 was smaller: 31.0% to 45.8%, (p<0.001). There was no difference in TFS survival in 2010-14 vs. 2015-20. Long-term TFS was poor with <20% of patients alive without LT 1-year after LITU admission. During follow-up 280 underwent LT: the proportion transplanted increased from 12.6% in 2000-09 to 20.2% in 2010-20, with 1- and 5-year post-transplant survival of 91% and 81.9%.CONCLUSIONS: TFS has now plateaued with need for novel interventions to improve survival in ACLF. Liver transplantation is infrequently utilised but has excellent outcomes. ACLF survivors should be closely followed up with strong consideration given for transplant assessment.

U2 - 10.1016/j.cgh.2025.04.029

DO - 10.1016/j.cgh.2025.04.029

M3 - Article

C2 - 40473089

SN - 1542-3565

JO - Clinical Gastroenterology and Hepatology : the official clinical practice journal of the American Gastroenterological Association

JF - Clinical Gastroenterology and Hepatology : the official clinical practice journal of the American Gastroenterological Association

ER -