■慢性急性肝衰竭(ACLF)患者在短时间内死亡率很高。本研究旨在比较移植ACLF患者与非移植ACLF患者和失代偿期肝硬化受者的预后。
■29例ACLF移植患者的临床数据,312例非移植ACLF患者,回顾性收集60例移植失代偿期肝硬化患者。采用倾向评分匹配(PSM)分析对不同组患者进行匹配。
■PSM后,ACLF移植患者的90天和1年生存期显著长于非移植对照组.尽管ACLF受者的90天生存率和1年生存率与失代偿期肝硬化对照相似,ACLF接受者被发现有更长的机械通气时间,更久的重症监护病房(ICU),住院时间更长,气管切开术的发生率较高,更高的费用,并发症的发病率高于相应的失代偿期肝硬化对照组。移植的ACLF2-3级患者的90天和1年生存率也明显长于未移植的对照组。
■肝移植能明显改善ACLF患者的预后。尽管有更多的负担(包括更长的机械通气,ICU停留时间更长,气管切开术的发生率较高,住院时间更长,住院费用较高,和更高的并发症发病率),ACLF受者可以获得与失代偿肝硬化受者相似的短期和长期生存。对于严重的ACLF患者,肝移植还可以显著提高其短期和长期生存率。
UNASSIGNED: Acute-on-chronic liver failure (ACLF) patients have high mortality in a short period of time. This study aimed to compare the prognosis of transplanted ACLF patients to that of nontransplanted ACLF patients and decompensated cirrhosis recipients.
UNASSIGNED: Clinical data of 29 transplanted ACLF patients, 312 nontransplanted ACLF patients, and 60 transplanted decompensated cirrhosis patients were retrospectively collected. Propensity score matching (PSM) analysis was used to match patients between different groups.
UNASSIGNED: After PSM, the 90-day and 1-year survival of transplanted ACLF patients was significantly longer than that of nontransplant controls. Although the 90-day survival and 1-year survival of ACLF recipients was similar to that of decompensated cirrhosis controls, ACLF recipients were found to have longer mechanical ventilation, longer intensive care unit (ICU) stay, longer hospital stay, higher incidence of tracheotomy, higher expense, and higher morbidity of complication than matched decompensated cirrhosis controls. The 90-day and 1-year survival of transplanted ACLF grade 2-3 patients was also significantly longer than that of nontransplanted controls.
UNASSIGNED: Liver transplantation can strongly improve the prognosis of ACLF patients. Despite having more burdens (including longer mechanical ventilation, longer ICU stay, higher incidence of tracheotomy, longer hospital stay, higher hospitalization expense, and higher complication morbidity), ACLF recipients can obtain similar short-term and long-term survival to decompensated cirrhosis recipients. For severe ACLF patients, liver transplantation can also significantly improve their short-term and long-term survival.