{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T03:05:30Z","timestamp":1782270330945,"version":"3.54.5"},"reference-count":14,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2023,12,1]],"date-time":"2023-12-01T00:00:00Z","timestamp":1701388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2024,1]]},"abstract":"Abstract<\/jats:title>Background & Aims<\/jats:title>Patients with acute liver failure (ALF) awaiting liver transplantation (LT) may develop multiorgan failure, but organ failure does not impact waitlist prioritization. The aim of this study was to examine the impact of organ failure on waitlist mortality risk and post LT outcomes in patients with ALF.<\/jats:p><\/jats:sec>Methods<\/jats:title>We studied adults waitlisted for ALF in the United Network for Organ Sharing (UNOS) database (2002\u20132019). Organ failures were defined using a previously described Chronic Liver Failure modified sequential organ failure score assessment adapted to UNOS data. Regression analyses of the primary endpoints, 30\u2010day waitlist mortality (Competing risk), and post\u2010LT mortality (Cox\u2010proportional hazards), were performed. Latent class analysis (LCA) was used to determine the organ failures most closely associated with 30\u2010day waitlist mortality.<\/jats:p><\/jats:sec>Results<\/jats:title>About 3212 adults with ALF were waitlisted, for hepatotoxicity (41%), viral (12%) and unspecified (36%) etiologies. The median number of organ failures was three (interquartile range 1\u20133). Having \u22653 organ failures (vs. \u22642) was associated with a sub hazard ratio (HR) of 2.7 (95%CI 2.2\u20133.4)) and a HR of 1.5 (95%CI 1.1\u20132.5)) for waitlist and post\u2010LT mortality, respectively. LCA identified neurologic and respiratory failure as most impactful on 30\u2010day waitlist mortality. The odds ratios for both organ failures (vs. neither) were higher for mortality 4.5 (95% CI 3.4\u20135.9) and lower for delisting for spontaneous survival .5 (95%CI .4\u2013.7) and LT .6 (95%CI .5\u2013.7).<\/jats:p><\/jats:sec>Conclusion<\/jats:title>Cumulative organ failure, especially neurologic and respiratory failure, significantly impacts waitlist and post\u2010LT mortality in patients with ALF and may inform risk\u2010prioritized allocation of organs.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.15215","type":"journal-article","created":{"date-parts":[[2023,12,2]],"date-time":"2023-12-02T17:00:27Z","timestamp":1701536427000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Severe hepatic encephalopathy with mechanical ventilation may inform waitlist priority in acute liver failure: A UNOS database analysis"],"prefix":"10.1111","volume":"38","author":[{"given":"Jiayi","family":"Ma","sequence":"first","affiliation":[{"name":"Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James E.","family":"Slaven","sequence":"additional","affiliation":[{"name":"Biostatistics and Health Data Science Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0837-0746","authenticated-orcid":false,"given":"Lauren","family":"Nephew","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavish R.","family":"Patidar","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archita P.","family":"Desai","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8295-9076","authenticated-orcid":false,"given":"Eric","family":"Orman","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4043-2943","authenticated-orcid":false,"given":"Chandrashekhar","family":"Kubal","sequence":"additional","affiliation":[{"name":"Transplant Surgery Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naga","family":"Chalasani","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan","family":"Ghabril","sequence":"additional","affiliation":[{"name":"Gastroenterology and Hepatology Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.7326\/M15-2211"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01709751"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.12659\/AOT.926453"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26563"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1002\/lt.26246"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2018.12.007"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16234"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1080\/01621459.1999.10474144"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000005194"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.14309\/00000434-201410002-00553"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.30624"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.14.1754"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2012.03.017"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.15215","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T08:34:02Z","timestamp":1741768442000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.15215"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2024,1]]}},"alternative-id":["10.1111\/ctr.15215"],"URL":"https:\/\/doi.org\/10.1111\/ctr.15215","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12]]},"assertion":[{"value":"2023-06-21","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication 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