EFFECTS OF AGING AND ACUTE-ON-CHRONIC LIVER FAILURE ON LIVER TRANSPLANT WAITLIST MORTALITY
Kitajima T, Kuno Y, Sukkarieh N, Suzuki Y, Shimada S, Flores A, Lisznyai E, Collins K, Yoshida A, Rizzari M, Moonka D, Abouljoud MS, and Nagai S. EFFECTS OF AGING AND ACUTE-ON-CHRONIC LIVER FAILURE ON LIVER TRANSPLANT WAITLIST MORTALITY. Hepatology 2020; 72:800A-801A.
Background: Acute-on-chronic liver failure (ACLF) is characterized by multiple organ failure with high short-term mortality. However, the effect of the severity of ACLF on waitlist outcomes in age groups has not been well elucidated. We hypothesized that the negative effect of ACLF may be different between age groups and older patients may increase the risk of waitlist mortality compared to younger population. The aim of this study is to investigate the effects of ACLF on waitlist mortality according to recipient age.
Methods: This study used data from the UNOS registry and evaluated adult patients listed for liver-only or liver-kidney transplant between 2014 and 2019. Patients listed as status 1A, multi- organ transplant, hepatocellular carcinoma, and re-transplant were excluded. We identified patients with ACLF using the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) criteria. Ninety-day waitlist mortality was compared between ACLF grades 1, 2, and 3 in each age group at listing (age<50 [younger], 50-64 [mid], ≥65 [older]). The risks of 90-day waitlist mortality were analyzed in ACLF patients using Fine-Gray competing risk regression model. Risk was adjusted by recipient characteristics at listing.
Results: Among the 30,486 patients eligible for the study, 6,316 (20.7%), 1,995 (6.5%) and 1,653 (5.4%) had ACLF 1,2 and 3, respectively. 7733 (25.3%) were in younger group, 17462 (57.3%) were in mid group, 5291 (17.4%) were in older group. In all age groups, ACLF 1, 2 and 3 groups showed significantly higher adjusted risk of 90-day waitlist mortality than those without ACLF (Figure). The adverse impact of ACLF on waitlist mortality was most significant in the older group. In patients with ACLF, higher grade of ACLF (ACLF- 2: adjusted hazard ratio [aHR] 1.33, P<0.001; ACLF-3: aHR 2.56, P<0.001; ref: ACLF-1) and older recipient age (mid: aHR 1.57, P<0.001: older: aHR 2.15, P<0.001; ref younger) independently increased the risk of 90-day waitlist mortality.
Conclusion: While ACLF negatively affected 90-day mortality for patients of all age groups on waitlist, this effect was more prominent in the older populations. Given this fact and the higher risk of waitlist mortality for those with ACLF, increased priority in liver allocation to these patients should be considered.