Post-liver transplantation outcomes in acute-on-chronic liver failure: Impact of alcohol as a precipitant and etiology of chronic liver disease

作者：Victoria Kusztos, Tiffany Wu, Blake Kassmeyer, Rubén Hernáez, Constantine Karvellas, Saro Khemichian, Lance L. Stein, Kirti Shetty, Christina C. Lindenmeyer, Justin Boike, Robert S. Rahimi, Jalal Prasun, Manhal Izzy, Michael Kriss, Gene Y. Im, Ming Lin, Janice H. Jou, Brett E. Fortune, George Cholankeril, Alexander Kuo, Douglas A. Simonetto · 发表于：Liver Transplantation · 年份：2025 · DOI：10.1097/lvt.0000000000000724 · 被引用次数：2 · 研究领域：Liver Disease and Transplantation、Alcohol Consumption and Health Effects、Liver Disease Diagnosis and Treatment

Acute-on-chronic liver failure (ACLF) has been associated with excellent post-liver transplant (LT) outcomes at 1 year; however, the impact of alcohol as ACLF precipitant, specifically alcohol-associated hepatitis (AH), and as etiology of chronic liver disease remains uncertain. This study aimed to assess the effect of alcohol as ACLF precipitant and chronic liver disease etiology (alcohol-associated liver disease vs. non-alcohol-associated liver disease) on posttransplant outcomes. We performed a retrospective study using the Multi-Organ Dysfunction and Evaluation for LT Consortium database and included 640 patients with ACLF who underwent LT across 15 transplant centers in North America. The primary outcome was 1-year posttransplant survival. We used logistic regression and Cox proportional hazards to compare posttransplant survival, mortality risk, and health care utilization, adjusting for age, ACLF grade, comorbid diabetes mellitus, chronic kidney disease, and HCC. The median follow-up from LT was 2.8 years (P25-P75, 2.2-5.5 y) for patients with AH-ACLF (n=42) and 3.1 years (P25-P75, 1.6-4.9 y) for patients without AH (n=598). No significant difference was observed in 1-year survival after LT in patients with AH-ACLF versus those without AH ( p =0.36). Patients with AH had significantly higher health care utilization evidenced by greater length of stay (28.5 vs. 19.0 d, p =0.004; adjusted linear estimate 16.89, 95% CI: 7.66-26.11, p <0.001), higher rates of rehabilitatio...