ArticleHepatology (Baltimore, Md.)2019
Patients With Acute on Chronic Liver Failure Grade 3 Have Greater 14-Day Waitlist Mortality Than Status-1a Patients.
Article in Hepatology (Baltimore, Md.), 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 50 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
50 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- AASLD AST Practice Guideline on adult liver transplantation: Candidate evaluation.Hepatology (Baltimore, Md.) · 2026Guideline
- Liver transplantation improves prognosis across all grades of acute-on-chronic liver failure patients: A systematic review and meta-analysis.World journal of gastroenterology · 2025Pooled it
- Asian Pacific Association for the Study of the Liver clinical practice guidelines on liver transplantation.Hepatology international · 2024Guideline
- Reversal of ACLF and ALF using whole blood extracorporeal system combining HLA-depleted liver organoids with granulocyte-monocyte apheresis.Journal of hepatology · 2026Article
- Impact of Donor Age on Liver Transplant Outcomes in Patients with Acute-on-Chronic Liver Failure: A Cohort Study.Gut and liver · 2025Article
- Extracorporeal liver support and liver transplantation for acute-on-chronic liver failure.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- Acute and non-acute decompensation of liver cirrhosis.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- Mechanisms and treatment approaches for ACLF.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- Management of the acute on chronic liver failure in the intensive care unit.Liver international : official journal of the International Association for the Study of the Liver · 2025Review
- Psychosocial Determinants and Outcomes of Expedited Liver Transplant Evaluations: Insights From a Retrospective Cohort Analysis.Transplantation direct · 2025Article
- Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025?Transplant international : official journal of the European Society for Organ Transplantation · 2025Review
- Common definitions and variables are needed for the United States to join the conversation on acute-on-chronic liver failure.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2024Article
- [Liver transplantation in acute and acute-on-chronic liver failure].Medizinische Klinik, Intensivmedizin und Notfallmedizin · 2024Review
- Liver function maximum capacity test during normothermic regional perfusion predicts graft function after transplantation.The EPMA journal · 2024Article
- Risk Evaluation and Recipient Selection in Adult Liver Transplantation: A Mixed-Methods Survey.Canadian liver journal · 2024Article
- Enhancing ACLF prediction by integrating sarcopenia assessment and frailty in liver transplant candidates on the waiting list.JHEP reports : innovation in hepatology · 2024Article
- [Transplantation for acute-on-chronic liver failure].Chirurgie (Heidelberg, Germany) · 2024Review
- Acute on chronic liver failure: A South Australian experience.JGH open : an open access journal of gastroenterology and hepatology · 2023Article
- Liver Transplantation Within 7-Days of Listing Improves Survival in ACLF-3.Digestive diseases and sciences · 2023Article
- Mortality scoring systems for liver transplant recipients: before and after model for end-stage liver disease score.Anesthesia and pain medicine · 2023Review
Corrections and comments
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Authors and funding
8 authors.
Funding
Abstract
Patients listed for liver transplantation (LT) as status 1a currently receive the highest priority on the waiting list. The presence of acute on chronic liver failure (ACLF) with three or more organs failing (ACLF-3) portends low survival without transplantation, which may not be reflected by the Model for End-Stage Liver Disease-Sodium (MELD-Na) score. We compared short-term waitlist mortality for patients listed status 1a and those with ACLF-3 at listing. Data were analyzed from the United Network for Organ Sharing database, years 2002-2014, for 3,377 patients listed status 1a and 5,099 patients with ACLF-3. Candidates with ACLF were identified based on the European Association for the Study of the Liver Chronic Liver Failure Consortium criteria. MELD-Na score was treated as a categorical variable of scores <36, 36-40, and >40. We used competing risks regression to assess waitlist mortality risk. Evaluation of outcomes through 21 days after listing demonstrated a rising trend in mortality among ACLF-3 patients at 7 days (18.0%), 14 days (27.7%), and 21 days (32.7%) (P < 0.001) compared to a stable trend in mortality among individuals listed as status 1a at 7 days (17.9%), 14 days (19.3%), and 21 days (19.8%) (P = 0.709). Multivariable modeling with adjustment for MELD-Na category revealed that patients with ACLF-3 had significantly greater mortality (subhazard ratio, 1.45; 95% confidence interval, 1.31-1.61) within 14 days of listing compared to status-1a candidates. Analysis of the interaction between MELD-Na category and ACLF-3 showed that patients with ACLF-3 had greater risk of 14-day mortality than status-1a-listed patients, across all three MELD-Na categories. Conclusion: Patients with ACLF-3 at the time of listing have greater 14-day mortality than those listed as status 1a, independent of MELD-Na score; these findings illustrate the importance of early transplant evaluation and consideration of transplant priority for patients with ACLF-3.
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