BACKGROUND & AIMS Little is known about outcomes of patients who underwent liver transplantation for acute on chronic liver failure (ACLF) and multiple organ failures. We compared Karnofsky Performance Status (KPS) before and after liver transplantation among patients with different numbers of organ failures and probable ACLF. METHODS We performed a retrospective cohort study of adults who underwent liver transplantation within 30 days of listing with the United Network for Organ Sharing (UNOS) network from January 1, 2006, through September 30, 2016. We determined the prevalence of organ failures using a modified version of the Chronic Liver Failure-Sequential Organ Failure Assessment scale and collected KPS scores at the time of transplantation and at intervals of 3 to 12 months after liver transplantation. Multivariate analyses were performed to adjust for confounders including UNOS region. RESULTS At the time of liver transplantation, 2838 patients had no organ failure, 2944 had 1 to 2 organ failures, and 1342 patients had 3 or more organ failures. KPS scores following liver transplantation improved significantly in all groups; scores ranged from 81 in patients with no organ failure to 72 in patients with 5 to 6 organ failures. Excellent performance status (KPS score, ≥80) by 1 year after transplantation was achieved by 60% of patients with 5 to 6 organ failures, 64% to 66% of patients with 3 to 4 organ failures, and 70% to 71% of patients with 1 to 2 organ failures, compared with 72.5% of patients without organ failure. Patients with 1 to 4 organ failure were more likely to achieve KPS scores of 80 or more than patients without organ failure, after we adjusted for other covariates and UNOS region. In addition, black patients were less likely, and patients with alcoholic cirrhosis were more likely, to have KPS scores of 80 or more after liver transplantation. CONCLUSIONS In a retrospective cohort study of patients with probable ACLF who underwent liver transplantation within 30 days of listing with the UNOS network, 60% to 66% of patients with 3 or more organ failures achieved excellent performance 3 to 12 months later.

中文翻译：

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多器官功能衰竭和可能的急性慢性肝衰竭患者肝移植后的Karnofsky行为状态。

背景与目的对于因慢性肝衰竭（ACLF）和多器官衰竭而进行急性肝移植的患者的预后知之甚少。我们比较了不同器官衰竭数目和可能的ACLF患者在肝移植前后的卡诺夫斯基表现状态（KPS）。方法我们对2006年1月1日至2016年9月30日期间在美国器官共享联合网络（UNOS）网络上市后30天内接受肝移植的成年人进行了一项回顾性队列研究。慢性肝功能衰竭-器官功能衰竭评估量表的修订版，并在移植时以及肝移植后3到12个月的间隔中收集KPS评分。进行了多变量分析，以适应包括UNOS地区在内的混杂因素。结果在肝移植时，2838例患者无器官功能衰竭，2944例发生1至2例器官功能衰竭，1342例发生3例或以上器官功能衰竭。所有组肝移植后的KPS评分均显着改善；评分范围从无器官衰竭患者的81分到5至6个器官衰竭患者的72分不等。移植后1年内，有5至6个器官衰竭的患者中有60％，有3至4个器官衰竭的患者中64％至66％和70％至71％的患者达到了优异的表现状态（KPS评分，≥80）。 1-2例器官功能衰竭的患者，而无器官衰竭的患者为72.5％。具有1至4个器官衰竭的患者比没有器官衰竭的患者更有可能获得80分以上的KPS评分，在我们针对其他协变量和UNOS地区进行调整之后。此外，在肝移植后，黑人患者发生KPS评分≥80的可能性较小，酒精性肝硬化患者则可能性较高。结论在一项回顾性队列研究中，使用UNOS网络在可能出现ACLF的患者在上市后30天内进行了肝移植，其中3％或更多器官衰竭的患者中有60％至66％在3至12个月后获得了出色的表现。