Severe hepatic encephalogaphy with mechanical ventilation may inform waitlist priority in acutve liver failure: A UNOS database analysis

dc.contributor.authorMa, Jiayi
dc.contributor.authorSlaven, James E.
dc.contributor.authorNephew, Lauren
dc.contributor.authorPatidar, Kavish R.
dc.contributor.authorDesai, Archita P.
dc.contributor.authorOrman, Eric
dc.contributor.authorKubal, Chandrashekhar
dc.contributor.authorChalasani, Naga
dc.contributor.authorGhabril, Marwan
dc.date.accessioned2025-06-02T15:57:15Z
dc.date.available2025-06-02T15:57:15Z
dc.date.issued2024
dc.description.abstractPatients with acute liver failure (ALF) awaiting liver transplantation (LT) may develop multiorgan failure, but organ failure does not impact waitlist prioritization. The aim of this study was to examine the impact of organ failure on waitlist mortality risk and post LT outcomes in patients with ALF. Methods We studied adults waitlisted for ALF in the United Network for Organ Sharing (UNOS) database (2002–2019). Organ failures were defined using a previously described Chronic Liver Failure modified sequential organ failure score assessment adapted to UNOS data. Regression analyses of the primary endpoints, 30-day waitlist mortality (Competing risk), and post-LT mortality (Cox-proportional hazards), were performed. Latent class analysis (LCA) was used to determine the organ failures most closely associated with 30-day waitlist mortality. Results About 3212 adults with ALF were waitlisted, for hepatotoxicity (41%), viral (12%) and unspecified (36%) etiologies. The median number of organ failures was three (interquartile range 1–3). Having ≥3 organ failures (vs. ≤2) was associated with a sub hazard ratio (HR) of 2.7 (95%CI 2.2–3.4)) and a HR of 1.5 (95%CI 1.1–2.5)) for waitlist and post-LT mortality, respectively. LCA identified neurologic and respiratory failure as most impactful on 30-day waitlist mortality. The odds ratios for both organ failures (vs. neither) were higher for mortality 4.5 (95% CI 3.4–5.9) and lower for delisting for spontaneous survival .5 (95%CI .4–.7) and LT .6 (95%CI .5–.7). Cumulative organ failure, especially neurologic and respiratory failure, significantly impacts waitlist and post-LT mortality in patients with ALF and may inform risk-prioritized allocation of organs.
dc.identifier.citationMa, J., Slaven, J. E., Nephew, L., Patidar, K. R., Desai, A. P., Orman, E., Kubal, C., Chalasani, N., & Ghabril, M. (2024). Severe hepatic encephalopathy with mechanical ventilation may inform waitlist priority in acute liver failure: A UNOS database analysis. Clinical Transplantation, 38(1), e15215. https://doi.org/10.1111/ctr.15215
dc.identifier.urihttps://hdl.handle.net/1805/48514
dc.language.isoen_US
dc.publisherWiley Online Library
dc.relation.isversionof10.1111/ctr.15215
dc.subjectAcute liver failure
dc.subjectliver transplant
dc.subjectorgan failure
dc.subjectsequential organ failure assessment
dc.subjectunited network for organ sharing
dc.subjectwaitlist mortality
dc.titleSevere hepatic encephalogaphy with mechanical ventilation may inform waitlist priority in acutve liver failure: A UNOS database analysis
dc.typeArticle
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