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.