Evidence map›Paper›PMID 34825154›Full record

ArticleJHEP reports : innovation in hepatology2021

Early transplantation maximizes survival in severe acute-on-chronic liver failure: Results of a Markov decision process model.

Suyanpeng Zhang, Sze-Chuan Suen, Cynthia L Gong, Jessica Pham, Jonel Trebicka, Christophe Duvoux, Andrew S Klein, Tiffany Wu, Rajiv Jalan, Vinay Sundaram

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JHEP reports : innovation in hepatology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers.

0numbers the graph read from it
0cells of the map it votes in
19citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

3 · Its place in the literature

Who cites it

19 citing papers in PubMed.

  1. Article
  2. Mechanisms and treatment approaches for ACLF.Liver international : official journal of the International Association for the Study of the Liver · 2025
    Review
  3. 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 · 2025
    Review
  4. 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 · 2025
    Review
  5. Article
  6. Strategic cancer therapy planning: optimizing treatment and quality of life with Markov decision processes.Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology · 2025
    Article
  7. From prognostication to therapeutics: Four key questions to accelerate the development of therapeutics for patients with acute-on-chronic liver failure.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2024
    Article
  8. Review
  9. [Transplantation for acute-on-chronic liver failure].Chirurgie (Heidelberg, Germany) · 2024
    Review
  10. Article
  11. Article
  12. Review
  13. Review
  14. Article
  15. Review
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

10 authors.

Suyanpeng ZhangDaniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
Sze-Chuan SuenDaniel J. Epstein Department of Industrial and Systems Engineering, Viterbi School of Engineering, University of Southern California, Los Angeles, CA, USA.
Cynthia L GongFetal & Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Jessica PhamSchool of Pharmacy, University of Southern California, Los Angeles, CA, USA.
Jonel TrebickaMedical Department I, Frankfurt University Hospital, Germany.
Christophe DuvouxMedical Liver Transplant Unit-Liver Department, Henri Mondor Hospital AP-HP, Paris Est University, Créteil, France.
Andrew S KleinDepartment of Surgery and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Tiffany WuDepartment of Medicine, Mayo Clinic, Rochester, MN, USA.
Rajiv JalanLiver Failure Group, Institute for Liver and Digestive Health, UCL Medical School, London, UK.
Vinay SundaramKarsh Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

BACKGROUND &

aimsUncertainties exist surrounding the timing of liver transplantation (LT) among patients with acute-on-chronic liver failure grade 3 (ACLF-3), regarding whether to accept a marginal quality donor organ to allow for earlier LT or wait for either an optimal organ offer or improvement in the number of organ failures, in order to increase post-LT survival.

methodsWe created a Markov decision process model to determine the optimal timing of LT among patients with ACLF-3 within 7 days of listing, to maximize overall 1-year survival probability.

resultsWe analyzed 6 groups of candidates with ACLF-3: patients age ≤60 or >60 years, patients with 3 organ failures alone or 4-6 organ failures, and hepatic or extrahepatic ACLF-3. Among all groups, LT yielded significantly greater overall survival probability

conclusionDuring the first week after listing for patients with ACLF-3, earlier LT in general is favored over waiting for an optimal quality donor organ or for recovery of organ failures, with the understanding that the analysis is limited to consideration of only these 3 variables. LAY SUMMARY: In the setting of grade 3 acute-on-chronic liver failure (ACLF-3), questions remain regarding the timing of transplantation in terms of whether to proceed with liver transplantation with a marginal donor organ or to wait for an optimal liver, and whether to transplant a patient with ACLF-3 or wait until improvement to ACLF-2. In this study, we used a Markov decision process model to demonstrate that earlier transplantation of patients listed with ACLF-3 maximizes overall survival, as opposed to waiting for an optimal donor organ or for improvement in the number of organ failures.

Indexed as

ACLF-3, acute-on-chronic liver failure grade 3ACLF, acute-on-chronic liver failuredonor risk indexDRI, donor risk indexMELD, model for end-stage liver diseaseMELD-Na scoreorgan failureUNOS databaseUNOS, United Network for Organ Sharing

Identifiers

PMID34825154
PMCPMC8603202

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.