{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,19]],"date-time":"2026-09-19T01:25:14Z","timestamp":1789781114157,"version":"4.0.1"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","license":[{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,2,9]],"date-time":"2022-02-09T00:00:00Z","timestamp":1644364800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Liver Transpl"],"published-print":{"date-parts":[[2022,6]]},"abstract":"<jats:p>\n                    Although liver transplantation (LT) yields survival benefit for patients with acute\u2010on\u2010chronic liver failure grade 3 (ACLF\u20103), knowledge gaps remain regarding risk factors for post\u2010LT mortality. We retrospectively reviewed data from 10 centers in the United States and Canada for patients transplanted between 2018 and 2019 and who required care in the intensive care unit prior to LT. ACLF was identified using the European Association for the Study of the Liver\u2010Chronic Liver Failure (EASL\u2010CLIF) criteria. A total of 318 patients were studied, of whom 106 (33.3%) had no ACLF, 61 (19.1%) had ACLF\u20101, 74 (23.2%) had ACLF\u20102, and 77 (24.2%) had ACLF\u20103 at transplantation. Survival probability 1 year after LT was significantly higher in patients without ACLF (94.3%) compared with patients with ACLF (87.3%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0=\u00a00.02), but similar between ACLF\u20101 (88.5%), ACLF\u20102 (87.8%), and ACLF\u20103 (85.7%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0=\u00a00.26). Recipients with ACLF\u20103 and circulatory failure (n\u00a0=\u00a029) had similar 1\u2010year post\u2010LT survival (82.3%) compared with patients with ACLF\u20103 without circulatory failure (89.6%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0=\u00a00.32), including those requiring multiple vasopressors. For patients transplanted with ACLF\u20103 including respiratory failure (n\u00a0=\u00a020), there was a trend toward significantly lower post\u2010LT survival (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0=\u00a0\u00a00.07) among those with respiratory failure (74.1%) compared with those without (91.0%). The presence of portal vein thrombosis (PVT) at LT for patients with ACLF\u20103 (n\u00a0=\u00a015), however, yielded significantly lower survival (91.9% versus 57.1%;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    \u00a0&lt;\u00a00.001). Multivariable logistic regression analysis revealed that PVT was significantly associated with post\u2010LT mortality within 1\u00a0year (odds ratio,\u00a07.3; 95% confidence interval, 1.9\u201028.3). No correlation was found between survival after LT and the location or extent of PVT, presence of transjugular intrahepatic portosystemic shunt, or anticoagulation. LT in patients with ACLF\u20103 requiring vasopressors yields excellent 1\u2010year survival. LT should be approached cautiously among candidates with ACLF\u20103 and PVT.\n                  <\/jats:p>","DOI":"10.1002\/lt.26408","type":"journal-article","created":{"date-parts":[[2022,1,12]],"date-time":"2022-01-12T10:22:33Z","timestamp":1641982953000},"page":"1078-1089","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":35,"title":["Risk Factors for Posttransplantation Mortality in Recipients With Grade 3 Acute\u2010on\u2010Chronic Liver Failure: Analysis of a North American Consortium"],"prefix":"10.1097","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1450-7756","authenticated-orcid":false,"given":"Vinay","family":"Sundaram","sequence":"first","affiliation":[{"name":"Karsh Division of Gastroenterology and Comprehensive Transplant Center, Department of Medicine,Cedars\u2010Sinai Medical Center,Los Angeles,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarvanand","family":"Patel","sequence":"additional","affiliation":[{"name":"Karsh Division of Gastroenterology and Comprehensive Transplant Center, Department of Medicine,Cedars\u2010Sinai Medical Center,Los Angeles,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirti","family":"Shetty","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Maryland Medical Center,Baltimore,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christina C.","family":"Lindenmeyer","sequence":"additional","affiliation":[{"name":"2569,Department of Gastroenterology, Hepatology and Nutrition,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2595-1852","authenticated-orcid":false,"given":"Robert S.","family":"Rahimi","sequence":"additional","affiliation":[{"name":"Annette C. and Harold C. Simmons Transplant Institute,Baylor University Medical Center,Baylor Scott and White,Dallas,TX"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianina","family":"Flocco","sequence":"additional","affiliation":[{"name":"Department of Medicine,University of Maryland Medical Center,Baltimore,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atef","family":"Al\u2010Attar","sequence":"additional","affiliation":[{"name":"Karsh Division of Gastroenterology and Comprehensive Transplant Center, Department of Medicine,Cedars\u2010Sinai Medical Center,Los Angeles,CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1555-1089","authenticated-orcid":false,"given":"Constantine J.","family":"Karvellas","sequence":"additional","affiliation":[{"name":"Department of Critical Care and Division of Gastroenterology (Liver Unit),University of Alberta,Edmonton,AB,Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suryanarayana","family":"Challa","sequence":"additional","affiliation":[{"name":"2569,Department of Gastroenterology, Hepatology and Nutrition,Cleveland Clinic,Cleveland,OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harapriya","family":"Maddur","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,Northwestern University,Chicago,IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janice H.","family":"Jou","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,Oregon Health and Sciences University,Portland,OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kriss","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,University of Colorado School of Medicine,Aurora,CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lance L.","family":"Stein","sequence":"additional","affiliation":[{"name":"Piedmont Transplant Institute,Piedmont Healthcare,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alex H.","family":"Xiao","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,Northwestern University,Chicago,IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross H.","family":"Vyhmeister","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,Oregon Health and Sciences University,Portland,OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2083-522X","authenticated-orcid":false,"given":"Ellen W.","family":"Green","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,Oregon Health and Sciences University,Portland,OR"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Braidie","family":"Campbell","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,University of Colorado School of Medicine,Aurora,CO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Cranford","sequence":"additional","affiliation":[{"name":"Piedmont Transplant Institute,Piedmont Healthcare,Atlanta,GA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1889-3954","authenticated-orcid":false,"given":"Nadim","family":"Mahmud","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,Hospital of the University of Pennsylvania,Philadelphia,PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0646-467X","authenticated-orcid":false,"given":"Brett E.","family":"Fortune","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology, Department of Medicine,Weill Cornell Medical College,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Multi\u2010Organ Dysfunction and Evaluation for Liver Transplantation (MODEL) Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,2,9]]},"reference":[{"key":"lt26408-bib-0001-20250824","doi-asserted-by":"crossref","first-page":"1426","DOI":"10.1053\/j.gastro.2013.02.042","article-title":"Acute\u2010on\u2010chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis","volume":"144","year":"2013","journal-title":"Gastroenterology"},{"key":"lt26408-bib-0002-20250824","doi-asserted-by":"crossref","first-page":"1932","DOI":"10.1002\/hep.31566","article-title":"Acute on chronic liver failure from nonalcoholic fatty liver disease: a growing and aging cohort with rising mortality","volume":"73","year":"2021","journal-title":"Hepatology"},{"key":"lt26408-bib-0003-20250824","doi-asserted-by":"crossref","first-page":"148","DOI":"10.1136\/gutjnl-2020-322161","article-title":"Global burden of disease: acute\u2010on\u2010chronic liver failure, a systematic review and meta\u2010analysis","volume":"71","year":"2022","journal-title":"Gut"},{"key":"lt26408-bib-0004-20250824","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1002\/hep.27849","article-title":"Clinical course of acute\u2010on\u2010chronic liver failure syndrome and effects on prognosis","volume":"62","year":"2015","journal-title":"Hepatology"},{"key":"lt26408-bib-0005-20250824","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/j.jhep.2018.04.016","article-title":"Class III obesity is a risk factor for the development of acute\u2010on\u2010chronic liver failure in patients with decompensated cirrhosis","volume":"69","year":"2018","journal-title":"J Hepatol"},{"key":"lt26408-bib-0006-20250824","doi-asserted-by":"crossref","first-page":"708","DOI":"10.1016\/j.jhep.2017.06.009","article-title":"Liver transplantation in the most severely ill cirrhotic patients: a multicenter study in acute\u2010on\u2010chronic liver failure grade 3","volume":"67","year":"2017","journal-title":"J Hepatol"},{"key":"lt26408-bib-0007-20250824","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1002\/hep.30624","article-title":"Patients with acute on chronic liver failure grade 3 have greater 14\u2010day waitlist mortality than status\u20101a patients","volume":"70","year":"2019","journal-title":"Hepatology"},{"key":"lt26408-bib-0008-20250824","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1016\/j.jhep.2018.07.007","article-title":"Liver transplantation in patients with multiple organ failures: feasibility and outcomes","volume":"69","year":"2018","journal-title":"J Hepatol"},{"key":"lt26408-bib-0009-20250824","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1016\/j.jhep.2021.03.030","article-title":"Liver transplantation for patients with acute\u2010on\u2010chronic liver failure (ACLF) in Europe: results of the ELITA\/EF\u2010CLIF collaborative study (ECLIS)","volume":"75","year":"2021","journal-title":"J Hepatol"},{"key":"lt26408-bib-0010-20250824","doi-asserted-by":"crossref","first-page":"2437","DOI":"10.1111\/ajt.15852","article-title":"Liver transplantation for critically ill cirrhotic patients: Stratifying utility based on pretransplant factors","volume":"20","year":"2020","journal-title":"Am J Transplant"},{"key":"lt26408-bib-0011-20250824","first-page":"1381","article-title":"Factors associated with survival of patients with severe acute on chronic liver failure before and after liver transplantation","volume":"156","year":"2018","journal-title":"Gastroenterology"},{"key":"lt26408-bib-0012-20250824","doi-asserted-by":"crossref","first-page":"1228","DOI":"10.1016\/j.jhep.2021.06.017","article-title":"'Equity' and 'Justice' for patients with acute\u2010on chronic liver failure: a call to action","volume":"75","year":"2021","journal-title":"J Hepatol"},{"key":"lt26408-bib-0013-20250824","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1097\/TP.0000000000003364","article-title":"When is a critically ill cirrhotic patient too sick to transplant? Development of consensus criteria by a multidisciplinary panel of 35 international experts","volume":"105","year":"2021","journal-title":"Transplantation"},{"key":"lt26408-bib-0014-20250824","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1111\/tri.13353","article-title":"Mortality in liver transplant recipients with portal vein thrombosis\u2014an updated meta\u2010analysis","volume":"31","year":"2018","journal-title":"Transpl Int"},{"key":"lt26408-bib-0015-20250824","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/TP.0000000000000785","article-title":"Portal vein thrombosis is a risk factor for poor early outcomes after liver transplantation: analysis of risk factors and outcomes for portal vein thrombosis in waitlisted Patients","volume":"100","year":"2016","journal-title":"Transplantation"},{"key":"lt26408-bib-0016-20250824","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40472-018-0175-z","article-title":"Simultaneous liver\u2010kidney transplantation: impact on liver transplant patients and the kidney transplant waiting list","volume":"5","year":"2018","journal-title":"Curr Transplant Rep"},{"key":"lt26408-bib-0017-20250824","doi-asserted-by":"crossref","first-page":"1153","DOI":"10.1002\/lt.24789","article-title":"The Braden Scale, A standard tool for assessing pressure ulcer risk, predicts early outcomes after liver transplantation","volume":"23","year":"2017","journal-title":"Liver Transpl"},{"key":"lt26408-bib-0018-20250824","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1002\/lt.24815","article-title":"Critical care management of the patient with cirrhosis awaiting liver transplant in the intensive care unit","volume":"23","year":"2017","journal-title":"Liver Transpl"},{"key":"lt26408-bib-0019-20250824","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1016\/j.jhep.2019.10.013","article-title":"Effect of the clinical course of acute on chronic liver failure prior to liver transplantation on post\u2010transplant survival","volume":"72","year":"2020","journal-title":"J Hepatol"},{"key":"lt26408-bib-0020-20250824","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1002\/cld.932","article-title":"PRO: portal vein thrombosis impacts liver transplantation outcomes","volume":"16","year":"2020","journal-title":"Clin Liver Dis"},{"key":"lt26408-bib-0021-20250824","first-page":"432","article-title":"Nontumoral portal vein thrombosis: a challenging consequence of liver cirrhosis","volume":"8","year":"2020","journal-title":"J Clin Transl Hepatol"},{"key":"lt26408-bib-0022-20250824","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1002\/cld.976","article-title":"Current concepts in coagulation profile in cirrhosis and acute\u2010on\u2010chronic liver failure","volume":"16","year":"2020","journal-title":"Clin Liver Dis"},{"key":"lt26408-bib-0023-20250824","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1002\/hep.30103","article-title":"Coagulation failure in patients with acute\u2010on\u2010chronic liver failure and decompensated cirrhosis: beyond the international normalized ratio","volume":"68","year":"2018","journal-title":"Hepatology"}],"container-title":["Liver Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/lt.26408","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/lt.26408","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.26408","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T21:03:53Z","timestamp":1756069433000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1002\/lt.26408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,9]]},"references-count":23,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.1002\/lt.26408","relation":{},"ISSN":["1527-6465","1527-6473"],"issn-type":[{"value":"1527-6465","type":"print"},{"value":"1527-6473","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,9]]},"assertion":[{"value":"2021-09-24","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-12-22","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}