Introduction:

Acute-on-chronic liver failure (ACLF) is a frequent presentation of acute decompensation in cirrhosis, characterised by multiorgan dysfunctions and associated with high mortality. This study aimed to analyse overall survival and the variables associated with mortality in patients diagnosed with ACLF who were evaluated for liver transplantation (LT) at the Bi-Institutional Liver Transplant Unit (Hospital de Clínicas - Hospital Central of the Armed Forces).

Methods:

We conducted a descriptive, longitudinal, historical cohort study of patients meeting ACLF criteria who were assessed for LT between January 2018 and July 2023. Variables were obtained by reviewing the electronic medical record.

Results:

Of 168 patients evaluated for LT, 24 % (n = 40) met ACLF criteria. Overall mortality was 67.5 %, with a statistically significant difference between non-transplanted (82.7 %) and transplanted patients (27.2 %). Mortality by ACLF grade was 55.5 % in ACLF-1, 68.8 % in ACLF-2, and 100 % in ACLF-3. Mortality was higher when the precipitating event was a concurrent bacterial infection (80 %) compared with other triggers.

Conclusions:

ACLF is a common indication for LT. Severity grade, precipitating factors such as concurrent bacterial infections, and timely access to transplantation have a significant impact on patient survival.

        · abstract in Spanish | Portuguese     · text in Spanish     · Spanish ( pdf )