Liver transplantation for acute liver failure in Europe: Outcomes over 20years from the ELTR database

Background & Aims Liver transplantation for acute liver failure (ALF) still has a high early mortality. We evaluated changes during 20years, and identified risk factors for poor outcome. Methods Donor, graft, and recipient variables from the European Liver Transplant Registry database (January 1988–June 2009), were analysed. Aetiologies and time periods were compared. Three and 12-month survival models were generated from separate training data sets, which were validated. A sub-analysis was performed for recipient older than 50years. Results Four thousand nine hundred and three patients were evaluated. One, 5- and 10-year patient, and graft survival rates were 74%, 68%, 63%, and 63%, 57%, 50%, respectively. Survival was better in 2004–2009 compared to previous quinquennia ( p 0.001), despite donors >60years increased from 1.8% to 21%. A higher incidence of suicide or non-adherence occurred in paracetamol-related ALF ( p 0.001). Death or graft loss were independently associated with male recipients (adjusted OR 1.25), recipient >50years (1.26), incompatible ABO matching (1.93), donors >60years (1.21), and reduced size graft (1.54). For both 3- and 12-month models, incompatible ABO matching, non-viral aetiology, reduced size graft, and non-UW preservation fluid were associated with increased mortality/graft loss, whereas male recipients and age >50years were associated only at 12months. Both models had reasonable discriminative ability with good calibration at 3months. Recipients >50years, combined with donors >60years resulted in 57% mortality/graft loss within the first year. Conclusions Survival after liver transplantation has improved despite increases in donor/recipient age. Recipients >50years paired with donors >60years had a very high mortality/graft loss within the first year.