Liver transplantation in the most severely ill cirrhotic patients: A multicenter study in acute-on-chronic liver failure grade 3
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...This emphasises the need for special management when transplanting patients with ACLF-3, with repeated systematic screening for infection and careful monitoring of renal and respiratory parameters.(434) Another point is that some patients with ACLF are potentially too sick for LT....
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...Thus, more data is needed to determine medical futility in patients with ALCF.(425,434) However, if LT is contraindicated or not available for patients with organ failures ≥4 or CLIF-C ACLFs >64 at days 3–7 after diagnosis of ACLF-3, the intensive organ support should be discontinued owing to futility....
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...Data on outcome of patients with ACLF treated with liver LT are scarce but nonetheless, patient survival at three-months after LT is about 80%, much higher than what would be anticipated if patients were not transplanted.(425,433,434) Almost all patients with ACLF-3 developed complications after LT, especially pulmonary, renal and infectious, compared to patients with no ACLF, or ACLF-1 and -2....
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...Univariable Cox proportional hazards models were also used to assess the value of the existing futility score in predicting one-year survival; the Harrell’s c index of agreement was also calculated [18]....
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