Journal article
Reduced short-term survival following liver transplant in patients with acute-on-chronic liver failure: Reevaluating OPTN data
Hepatology communications, Vol.9(3), e0651
03/01/2025
DOI: 10.1097/HC9.0000000000000651
PMCID: PMC11841847
PMID: 39969433
Abstract
Background:
Prior studies show severe acute-on-chronic liver failure (ACLF) at liver transplantation (LT) negatively impacts short-term, but not long-term, post-LT outcomes. However, not accounting for ACLF’s time-varying effect on the waitlist may underappreciate its dynamic nature. Moreover, excluding those who died or dropped off the waitlist raises concerns about selection bias.
Methods:
This US nationwide retrospective cohort study estimated the effect of severe ACLF (grade 3) (ACLF-3) on post-LT outcomes, including adult, first-time deceased donor LT candidates listed from June 2013 to May 2023. A marginal structural model (MSM) to address selection bias and time-varying exposure (ACLF-3) was applied, with extended Cox proportional hazard models using a Heaviside step function to assess the hazard of death after LT.
Results:
Among 31,267 eligible candidates for LT (baseline cohort), 11.3% (n = 3518) had ACLF-3 at listing; 13.6% (n = 4243) died or dropped out while on the LT waitlist. Of the 27,024 patients who received LT (transplanted cohort), 12.3% (n = 3333) had ACLF-3 at LT. ACLF-3 at LT (but not at waitlisting) was associated with a higher hazard of death, with the hazard ratio of 1.80 (95% CI: 1.09–2.97) within 1 year after LT but not thereafter. This marginal structural model effect size was 9% higher than conventional multivariable Cox proportional hazard models. Sensitivity analyses corroborated these findings.
Conclusions:
Compared to previous studies, ACLF-3 at LT in our marginal structural model was associated with a discernible increase in short-term mortality after transplant, presumably due to our addressing of selection bias, while long-term survival was similar to those without severe ACLF at LT. However, potential vulnerability to posttransplant complications warrants further investigation.
Details
- Title: Subtitle
- Reduced short-term survival following liver transplant in patients with acute-on-chronic liver failure: Reevaluating OPTN data
- Creators
- Tomohiro Tanaka - University of IowaEmily K. Roberts - University of IowaJonathan Platt - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Hepatology communications, Vol.9(3), e0651
- DOI
- 10.1097/HC9.0000000000000651
- PMID
- 39969433
- PMCID
- PMC11841847
- NLM abbreviation
- Hepatol Commun
- ISSN
- 2471-254X
- eISSN
- 2471-254X
- Publisher
- Lippincott Williams & Wilkins; PHILADELPHIA
- Language
- English
- Date published
- 03/01/2025
- Academic Unit
- Health Management and Policy; Epidemiology; Gastroenterology and Hepatology; Biostatistics; Center for Social Science Innovation; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984790994602771
Metrics
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