Review highlights the diversity of factors that affect the origin of the disease as
an obstacle in the standardization of criteria for selecting candidates for liver
transplantation. The use of support systems to replace liver functions improves
the prognosis, but has not yet shown an impact on the survival rate of patients.
Article: Dias DM, Diogo D, Madaleno J, Tralhão JG. Selection liver transplantation and bridge therapeutic modalities in acute liver failure. Brazilian Journal of Transplantation, 2023.26 (01):e0823. https://doi.org/10.53855/bjt.v26i1.457_ENG
Acute liver failure: How to obtain accurate markers to identify liver transplant prognosis?
Acute liver failure is distinguished by rapid deterioration of liver function without a patient having previous chronic liver disease. It manifests through jaundice (yellow discoloration of the skin), problems with blood clotting (coagulopathies), and changes in the patient's brain functions, caused by toxins not eliminated by the liver. The latter, called hepatic encephalopathy, is a crucial factor in the diagnosis and must be carefully monitored, as liver failure occurs in patients without preexisting liver problems and can trigger multiple organ system failure.
Considering the high complexity, risks, and hospital costs demanded by a transplant, along with the limitation of available grafts, the indication for the procedure must appraise some criteria that indicate the probable evolution of the patient's condition.
Researchers from the Faculty of Medicine of the University of Coimbra, in Portugal, accomplished a literature review to analyze the markers currently used as a parameter in the selection of transplant candidates. The investigation, carried out from October to December 2021, included articles from the PubMed® and MEDLINE databases, and the article is presented in vol. 26 of the Brazilian Journal of Transplantation.
The impact of using extracorporeal artificial and bioartificial systems, which replace liver functions, was also discussed, for gaining time for the patient waiting for a graft, improving the postoperative prognosis, and even helping in the regeneration of the organ, avoiding unnecessary transplants.
Several analyses brought to the scene, such as McPhail et al. (2010), point out that the King's College (CKC) criteria are still the most used parameters in the world for indicating liver transplantation. However, none of the markers currently applied can deliver sensitivity and specificity in a completely satisfactory way in both aspects. There are records of several studies that seek to improve the accuracy of these criteria.
The results indicated that the analysis of the etiology of acute liver failure plays a fundamental role in the projection of its evolution. However, there is a wide range of variations in the origin of acute liver failure, and the etiology of the condition plays a determining role in analyzing the prognosis and adopting the most appropriate bridging therapies. Even social geographical aspects influence
the origin of pathology among patients, and the results presented in a region should be interpreted with caution concerning patients from other contexts, as warned by Zabron et al. (2018) about studies on the potential of computed tomography as a prognostic model, carried out in Japan.
Regarding the application of extracorporeal liver support systems, the artificial ones, based on dialysis and plasma adsorption techniques, performed better than the bioartificial ones, based on cells, although neither of the two modalities had a significant impact on the patient's survival rate, showing that such measures still do not replace the transplant.
The authors conclude that the wide variety of causes and origins of liver failure hinders a satisfactory standardization of selection criteria for transplant candidates. The heterogeneity of the syndrome is a limiting factor for the quality of the studies, and more research is needed to validate increasingly accurate parameters to assess the prognosis and determine the impact of available
bridging therapies.
Read more (References):
McPhail MJ, Wendon JA, Bernal W. Meta-analysis of performance of Kings's College Hospital Criteria in prediction of outcome in non-paracetamol-induced acute liver failure. J Hepatol. 2010;53(3):492-499. doi:10.1016/j.jhep.2010.03.023
Zabron A, Quaglia A, Fatourou E, et al. Clinical and prognostic associations of liver volume determined by computed tomography in acute liver failure. Liver Int. 2018;38(9):1592-1601. doi:10.1111/liv.13725
Author
Rosa Emilia Moraes, Scientific journalist at Linceu Editorial, São José dos Campos, SP, Brazil (rosaemiliamoraes@gmail.com)
Links
Brazilian Journal of Transplantation
Faculdade de Medicina da Universidade de Coimbra (FMUC)
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