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Long-term Outcomes of Emergency Liver Transplantation for Acute Liver Failure
Liver Transplantation (2009)
  • Gabriel Chan
  • Ali Taqi
  • Paul Marotta
  • Mark Levstik
  • Vivian McAlister, The University of Western Ontario
  • William Wall
  • Douglas Quan

Acute liver failure continues to be associated with a high mortality rate, and emergency liver transplantation is often the only life-saving treatment. The short-term outcomes are decidedly worse in comparison with those for nonurgent cases, whereas the long-term results have not been reported as extensively. We report our center's experience with urgent liver transplantation, long-term survival, and major complications. From 1994 to 2007, 60 patients had emergency liver transplantation for acute liver failure. The waiting list mortality rate was 6%. The mean waiting time was 2.7 days. Post-transplantation, the perioperative mortality rate was 15%, and complications included neurological problems (13%), biliary problems (10%), and hepatic artery thrombosis (5%). The 5- and 10-year patient survival rates were 76% and 69%, respectively, and the graft survival rates were 65% and 59%. Recipients of blood group-incompatible grafts had an 83% retransplantation rate. Univariate analysis by Cox regression analysis found that cerebral edema and extended criteria donor grafts were associated with worse long-term survival. Severe cerebral edema on a computed tomography scan pre-transplant was associated with either early mortality or permanent neurological deficits. The keys to long-term success and continued progress in urgent liver transplantation are the use of good-quality whole grafts and a short waiting list time, both of which depend on access to a sufficient pool of organ donors. Severe preoperative cerebral edema should be a relative contraindication to transplantation.

  • Brain Edema,
  • Emergency Treatment,
  • Kaplan-Meiers Estimate,
  • Liver Failure,
  • Liver Transplantation,
  • Nervous System Diseases,
  • Proportional Hazards Models,
  • Risk Assessment,
  • Time Factors,
  • Tissue Donors,
  • Treatment Outcome
Publication Date
December, 2009
Citation Information
Gabriel Chan, Ali Taqi, Paul Marotta, Mark Levstik, et al.. "Long-term Outcomes of Emergency Liver Transplantation for Acute Liver Failure" Liver Transplantation Vol. 15 Iss. 12 (2009)
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