Portal de investigación
Pre-liver transplant assessment of patients with acute-on-chronic liver failure: An international survey
Fecha de publicación:
Fecha Ahead of Print:
Autores de IIS La Fe
Participantes ajenos a IIS La Fe
- Bellec C.
- Augé A.
- L'Hermite S.
- Moirand R.
- Abergel A.
- Amstrong M.
- Antonini T.
- Anty R.
- Khaldi M.
- Baron A.
- Bensenane-Oussalah M.
- Bernal W.
- Bureau C.
- Carbonell N.
- Cadranel J.-F.
- Cardoso F.
- Carrier P.
- Coilly A.
- Conti F.
- Bonadona A.
- Crespo G.
- Murad S.D.
- Dharancy S.
- Duvoux C.
- Engelmann C.
- Faitot F.
- Francoz C.
- Garioud A.
- Gerolami R.
- Gigante E.
- Goria O.
- Gustot T.
- Hogan B.
- Lagin L.
- Lannes A.
- Latournerie M.
- de Ledinghen V.
- Magini G.
- Mateo M.
- Maurin A.
- Merli M.
- Meszaros M.
- Pageaux G.-P.
- Perignon C.
- Perricone G.
- Praktiknjo M.
- Reboux N.
- Reiberger T.
- Rolle V.
- Rosa I.
- Sarba R.
- Wartel F.
- Weil D.V.
- Zanetto A.
- Elkrief L.
- Artru F.
Grupos
Abstract
Background & Aims: Liver transplantation (LT) is increasingly performed in the setting of acute-on-chronic liver failure (ACLF). In this context, pre-transplant evaluation must be completed rapidly while minimizing the risk of overlooking contraindications. We aimed to describe current practices for pre-transplant assessment in patients with ACLF. Methods: We conducted a survey across 34 European LT centers (including 16 French) and 22 French non-LT centers to assess pre-transplant evaluation practices, focusing on cardiopulmonary, addiction, oncological, and nutritional assessments. Practices were compared across three clinical scenarios: outpatients (OutPat), hospitalized decompensated patients without ACLF (Hosp), and patients with ACLF admitted to intensive care units (ACLF-ICU). In parallel, we retrospectively evaluated post-transplant outcomes in patients with cirrhosis and severe ACLF transplanted in two high-volume centers. Results: Fifty-three centers (96%) responded. Cardiological stress testing was reported in 2% of ACLF-ICU patients vs. 21% of OutPat (p = 0.002) vs. 17% of Hosp patients (p = 0.008). Coronary angiography following abnormal non-invasive testing was less frequently performed in ACLF (42%) than in OutPat (76%, p = 0.0004) or Hosp patients (66%, p = 0.01). Alcohol abstinence requirements were more often decided on a case-by-case basis in patients with ACLF (62%) than in OutPat or Hosp patients. Oncological screening, including colonoscopy and ear, nose, and throat consultation, was also less frequently performed in ACLF-ICU patients. Median time from assessment initiation to listing was 7 days in ACLF-ICU vs. 45 days in OutPat and 18 days in Hosp patients (both p <0.0001). In the retrospective cohort (n = 221), patients listed after ACLF onset had a higher 1-year incidence of cardiovascular events than those listed before ACLF onset (19% vs. 9%). Conclusions: In ACLF-ICU patients, pre-transplant evaluation is markedly abbreviated, with critical gaps—particularly in cardiological assessment—highlighting the need for dedicated, evidence-based guidelines. Impact and implications: We sent a questionnaire to centers with an expertise in the management of patients with ACLF to assess current practices in pre-transplant evaluation in patients with ACLF admitted to an intensive care unit, as compared with patients without (outpatients and patients hospitalized in a regular ward). According to the responses from 53 centers, cardiological stress test and coronary angiography were less commonly performed as part of the pre-transplant evaluation in patients with ACLF admitted to the ICU, as well as colonoscopy and ear, nose, and throat consultation. Median timeframe from pre-LT workup initiation to listing was 7 days in patients with ACLF admitted to the ICU, which was significantly shorter than in patients without ACLF. These results suggest that pre-transplant workup is abbreviated in patients with ACLF, and might have an impact on post-transplant outcome, especially cardiovascular complications. Further dedicated studies are needed to specifically address the relation between pre-transplant workup and post-LT complications in patients with ACLF. © 2026 The Author(s)
Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.
Datos de la publicación
- ISSN/ISSNe:
- 2589-5559, 2589-5559
- Tipo:
- Article
- Páginas:
- 101794-101794
- PubMed:
- 42391791
- Enlace a otro recurso:
- www.scopus.com
- Factor de Impacto:
- 2,835 SCImago ℠
- Cuartil:
- Q1 SCImago ℠
JHEP Reports ELSEVIER
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- No hay documentos
Filiaciones
Keywords
- acute on chronic liver failure; adult; alcohol abstinence; Article; cardiac stress testing; clinical assessment; cohort analysis; colonoscopy; computer assisted tomography; consultation; controlled study; coronary angiography; disease severity; electrocardiography; female; France; heart catheterization; hospital patient; human; liver cirrhosis; liver transplantation; lung function test; major clinical study; male; mammography; nutritional assessment; outpatient; retrospective study; transthoracic echocardiography
Cita
Bellec C,Augé A,L'Hermite S,Moirand R,Abergel A,Amstrong M,Antonini T,Anty R,Khaldi M,Baron A,Bensenane M,Bernal W,Bureau C,Carbonell N,Cadranel J-F,Cardoso F,Carrier P,Coilly A,CONDE I,Conti F,Bonadona A,Crespo G,Murad SD,Dharancy S,Duvoux C,Engelmann C,Faitot F,Francoz C,Garioud A,Gerolami R,Gigante E,Goria O,Gustot T,Hogan B,Lagin L,Lannes A,Latournerie M,de Ledinghen V,Magini G,Mateo M,Maurin A,Merli M,Meszaros M,Pageaux G-P,Perignon C,Perricone G,Praktiknjo M,Reboux N,Reiberger T,Rolle V,Rosa I,Sarba R,Wartel F,Weil DV,Zanetto A,Elkrief L,Artru F. Pre-liver transplant assessment of patients with acute-on-chronic liver failure: An international survey. JHEP Rep. 2026. 8. (8):p. 101794-101794. IF:8,700. (1).