The aim of this study is to report on the liver transplantation (LT) activity and posttransplant outcome, over time, of patients with grade 3 acute-on-chronic liver failure (ACLF-3) in a single transplant center performing a large number of LTs for patients with ACLF-3. It aims at showing how pre-LT intensive care unit (ICU) management impacts post-LT outcomes, in particular through monitoring the transplantation for ACLF-3 model (TAM) score. A total of 100 patients who had ACLF-3 at the time of LT between 2007 and 2019 were included retrospectively. The cohort was divided in 2 periods, with 50 patients in each period. There was an increase in the number of patients with ACLF-3 who received an LT during the course of the study period and significantly higher 1-year post-LT survival rates in the second period compared with the first period (86% versus 66%, respectively; P = 0.02). Interestingly, patients during both periods had similar severity profiles and scores apart from a significantly lower number of patients with TAM scores >2 at the time of LT in the second period compared with the first period (1 [2%] versus 11 [22%], respectively; P ≤ 0.01). In addition, patients whose clinical condition improved in the ICU (with a TAM score downstaged between admission and LT) had significantly higher post-LT survival rates than those whose TAM score stayed the same or increased: 88% versus 70%, respectively (P = 0.04). This study shows a learning curve in LT for patients with ACLF-3, with optimized ICU management and patient selection leading to increased numbers of LTs for patients with ACLF-3 and improved post-LT outcomes. It also delineates how the TAM score can be used to identify the optimal transplantability window for patients with ACLF-3.

中文翻译：

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移植前重症监护病房管理和 3 级慢加急性肝衰竭移植候选人的选择

本研究的目的是报告在一个移植中心进行大量肝移植的 3 级慢加急性肝衰竭 (ACLF-3) 患者的肝移植 (LT) 活动和移植后结果。 ACLF-3 患者的 LT。它旨在展示 LT 前重症监护病房 (ICU) 管理如何影响 LT 后结果，特别是通过监测移植的 ACLF-3 模型 (TAM) 评分。回顾性纳入了 2007 年至 2019 年间 LT 时 ACLF-3 的 100 名患者。该队列分为 2 个时期，每个时期有 50 名患者。P  = 0.02）。有趣的是，与第一期相比，第二期 LT 时 TAM 评分 >2 的患者数量明显低于第一期（1 [2%] 对 11 [22% ], 分别; P  ≤ 0.01). 此外，在 ICU 中临床状况改善的患者（入院和 LT 之间 TAM 评分降低）的 LT 后存活率显着高于 TAM 评分保持不变或增加的患者：分别为 88% 和 70%（P = 0.04）。这项研究显示了 ACLF-3 患者的 LT 学习曲线，优化的 ICU 管理和患者选择导致 ACLF-3 患者的 LT 数量增加，并改善了 LT 后结果。它还描述了如何使用 TAM 评分来确定 ACLF-3 患者的最佳移植窗口。