Systematic review with meta-analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure

2020 ◽  
Vol 52 (2) ◽  
pp. 222-232 ◽  
Author(s):  
Mohamed A. Abdallah ◽  
Muhammad Waleed ◽  
Matthew G. Bell ◽  
Morgan Nelson ◽  
Robert Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Liver Transplant ◽  
Survival Benefit ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Chronic Liver Failure

Granulocyte colony-stimulating factor in acute-on-chronic liver failure: systematic review and meta-analysis

2020 ◽  
Vol 73 ◽  
pp. S502-S503
Author(s):  
Rosa Martin-Mateos ◽  
Rosario González Alonso ◽  
Alfonso Muriel ◽  
Noelia Álvarez ◽  
Alexandre Figueroa Tubio ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Chronic Liver Failure ◽  
Stimulating Factor

scholarly journals Granulocyte-colony stimulating factor for acute-on-chronic liver failure: systematic review and meta-analysis

2015 ◽  
Vol 14 (5) ◽  
pp. 631-641 ◽  
Author(s):  
Norberto C. Chavez-Tapia ◽  
Indira Mendiola-Pastrana ◽  
Victoria J. Ornelas-Arroyo ◽  
Camilo Noreña-Herrera ◽  
Desiree Vidaña-Perez ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Granulocyte Colony Stimulating Factor ◽  
Colony Stimulating Factor ◽  
Chronic Liver Failure ◽  
Stimulating Factor

scholarly journals Su1147 – Bleeding and Thrombosis Risk in Crtically Ill Patients with Acute Or Chronic Liver Failure: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 156 (6) ◽  
pp. S-515
Author(s):  
Raj Shah ◽  
Constantine Karvellas ◽  
Beverley Kok ◽  
KHALIL i. ALSHAMMARI ◽  
Rebecca Morgan
Keyword(s):  
Systematic Review ◽  
Liver Failure ◽  
Meta Analysis ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Thrombosis Risk

scholarly journals Uncertainty in the impact of liver support systems in acute-on-chronic liver failure: a systematic review and network meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Klementina Ocskay ◽  
Anna Kanjo ◽  
Noémi Gede ◽  
Zsolt Szakács ◽  
Gabriella Pár ◽  
...  
Keyword(s):  
Liver Failure ◽  
Support Systems ◽  
Meta Analysis ◽  
Statistical Significance ◽  
Bioartificial Liver ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Liver Support ◽  
Bioartificial Liver Support ◽  
The Impact

Abstract Background The role of artificial and bioartificial liver support systems in acute-on-chronic liver failure (ACLF) is still controversial. We aimed to perform the first network meta-analysis comparing and ranking different liver support systems and standard medical therapy (SMT) in patients with ACLF. Methods The study protocol was registered with PROSPERO (CRD42020155850). A systematic search was conducted in five databases. We conducted a Bayesian network meta-analysis of randomized controlled trials assessing the effect of artificial or bioartificial liver support systems on survival in patients with ACLF. Ranking was performed by calculating the surface under cumulative ranking (SUCRA) curve values. The RoB2 tool and a modified GRADE approach were used for the assessment of the risk of bias and quality of evidence (QE). Results In the quantitative synthesis 16 trials were included, using MARS®, Prometheus®, ELAD®, plasma exchange (PE) and BioLogic-DT®. Overall (OS) and transplant-free (TFS) survival were assessed at 1 and 3 months. PE significantly improved 3-month OS compared to SMT (RR 0.74, CrI: 0.6–0.94) and ranked first on the cumulative ranking curves for both OS outcomes (SUCRA: 86% at 3 months; 77% at 1 month) and 3-month TFS (SUCRA: 87%) and second after ELAD for 1-month TFS (SUCRA: 76%). Other comparisons did not reach statistical significance. QE was moderate for PE concerning 1-month OS and both TFS outcomes. Other results were of very low certainty. Conclusion PE seems to be the best currently available liver support therapy in ACLF regarding 3-month OS. Based on the low QE, randomized trials are needed to confirm our findings for already existing options and to introduce new devices.

scholarly journals Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure: focus on treatment intensity

2019 ◽  
Vol 12 ◽  
pp. 175628481987956 ◽  
Author(s):  
Rafael Bañares ◽  
Luis Ibáñez-Samaniego ◽  
Josep María Torner ◽  
Marco Pavesi ◽  
Carmen Olmedo ◽  
...  
Keyword(s):  
Liver Failure ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Chronic Liver ◽  
Treatment Intensity ◽  
Chronic Liver Failure ◽  
Albumin Dialysis ◽  
Liver Support ◽  
Molecular Adsorbent Recirculating System

Background: Acute-on-chronic liver failure (ACLF) is a common complication of cirrhosis characterized by single or multiple organ failures and high short-term mortality. Treatment of ACLF consists of standard medical care (SMC) and organ(s) support. Whether the efficacy of artificial liver support (ALS) depends on the severity of ACLF or on the intensity of this treatment, or both, is unclear. This study aimed to further assess these issues. Methods: We performed an individual patient data meta-analysis assessing the efficacy of Molecular Adsorbent Recirculating System (MARS) in ACLF patients enrolled in prior randomized control trials (RCTs). The meta-analysis was designed to assess the effect of patient severity (ACLF grade) and treatment intensity [low-intensity therapy (LIT), SMC alone or SMC plus ⩽ 4 MARS sessions, high-intensity therapy (HIT), SMC plus > 4 MARS sessions] on mortality. Results: Three RCTs suitable for the meta-analysis ( n = 285, ACLF patients = 165) were identified in a systematic review. SMC plus MARS (irrespective of the number of sessions) did not improve survival compared with SMC alone, neither in the complete population nor in the ACLF patients. Survival, however, was significantly improved in the subgroup of patients receiving HIT both in the entire cohort (10-day survival: 98.6% versus 82.8%, p = 0.001; 30-day survival: 73.9% versus 64.3%, p = 0.032) and within the ACLF patients (10-day survival: 97.8% versus 78.6%, p = 0.001; 30-day survival: 73.3% versus 58.5%, p = 0.041). Remarkably, HIT increased survival independently of ACLF grade. Independent predictors of survival were age, Model for End-Stage Liver Disease (MELD), ACLF grade, number of MARS sessions received, and intensity of MARS therapy. Conclusion: HIT with albumin dialysis may improve survival in patients with ACLF. Appropriate treatment schedules should be determined in future clinical trials.

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