Liver transplantation for critically ill cirrhotic patients: Results from the French transplant registry - 06/07/22
, Camille Legeai b, Corinne Antoine b, Carine Jasseron b, Baptiste Michard a, François Faitot a, Francis Schneider a, Philippe Bachellier aCollaborators1
Highlights |
• | Cirrhotic patients transplanted from the ICU have increased post-transplant mortality. |
• | Identifying patients transplanted from the ICU who have poor post-transplant prognosis is essential in order to balance individual and collective utility. |
• | Among cirrhotic patients transplanted from the ICU, four independent factors were associated with poorer prognosis: recipient age, diabetes, intubation prior to transplantation and donor age. |
• | The rate of cirrhotic patients transplanted from the ICU varies greatly among French centers, reflecting diverging approaches to the complex issue of transplanting critically ill cirrhotic patients. |
Abstract |
This study describes the population of cirrhotic patients who were transplanted from the ICU in France, identifying pre-transplant risk factors of post-transplant mortality and describing geographic variations in ICU transplant activity.
Cirrhotic patients transplanted between 2008 and 2018 were included through the national transplant registry. The demographic, clinical and biological characteristics of the patients transplanted from the ICU were compared to cirrhotic patients who were transplanted from home or from the hospital. Risk factors of post-transplant one-year mortality were identified in uni- and multivariable analysis within the population transplanted from the ICU. Funnel plots were used to illustrate center-specific differences in ICU transplant activity.
1,047 cirrhotic patients were transplanted from the ICU during the study period. While the national rate of transplants performed from the ICU was 14.3% the absolute number and the rate of cirrhotic patients transplanted from the ICU varied significantly from one center to another, ranging from 6.6% to 22.8% (p < 0.05). Three recipient-associated independent risk factors one-year post-LT mortality were identified in the population transplanted from the ICU: age > 50 years (HR 1.65, 95%CI 1.16–2.36), p = 0.005), diabetes (HR 1.46, 95%CI 1.07–1.98, p = 0.02) and intubation (HR2.12, 95%CI 1.62-2.78), p < 0.001). Donor age was also independently associated with mortality (HR 1.01, 95%CI 1.01–1.02, p < 0.001). Funnel plots showed significant differences in the proportion of patients transplanted from the ICU and the distribution of risk factors across French transplant centers, especially the inclination to transplant intubated patients.
This study underlines the increased post-transplant mortality among cirrhotic patients transplanted from the ICU. It identifies four clinically pertinent independent risk factors associated with post-transplant mortality in this specific sub-group of transplant candidates. Finally, it illustrates how diverse the landscape of liver transplantation for critically ill cirrhotic patients is across a single country, despite a unified allocation algorithm.
Le texte complet de cet article est disponible en PDF.Abbreviations : ACLF, BMI, HCC, ICU, LT, MELD
Plan
Vol 46 - N° 6
Article 101817- juin 2022 Retour au numéro
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