Comorbidity burden may be associated with increased mortality in patients with severe acute liver injury referred for liver transplantation

Lindsey Steiner-Temnykh, Lara Dakhoul, James Slaven, Lauren Nephew, Kavish R. Patidar, Eric Orman, Archita P. Desai, Eduardo Vilar-Gomez, Chandrashekhar Kubal, Burcin Ekser, Naga Chalasani, Marwan Ghabril

Research output: Contribution to journalArticlepeer-review


Background: Material/Methods: Results: Conclusions: Severe acute liver injury (S-ALI) can lead to acute liver and multisystem failure, with high mortality and need for liver transplantation (LT); however, the burden and impact of liver disease and comorbid conditions are unknown. We assessed liver disease and Charlson Comorbidity Index (CCI) in adults without cirrhosis evaluated for LT at our center for S-ALI between 2004 and 2017. The study endpoints were 30-day death or LT and 90-day mortality (with LT as a competing risk). A total of 136 patients with S-ALI were included; 13% had underlying liver disease and a higher Model for End-stage Liver Disease score than those without liver disease. Sixty patients (41%) died or underwent LT within 30 days. They were older and more frequently female and had disease of autoimmune, viral, or indeterminate etiology. Transplant-free survival was associated with acetaminophen injury. The mean CCI was higher in patients with 30-day mortality or LT (1.5±2.4) vs. LT-free survivors (0.8±1.2), (P=0.03). Beyond severity of illness, CCI was associated with increased 90-day mortality (subhazard ratio 1.17, 95% confidence interval, 1.01–1.35) but not 30-day mortality or LT in the risk-adjusted analyses. Comorbidity burden may be an important modifier of transplant-free survival in patients with S-ALI, but fur-ther studies are needed to validate these findings.

Original languageEnglish (US)
Article numbere926453
Pages (from-to)1-13
Number of pages13
JournalAnnals of Transplantation
StatePublished - 2020
Externally publishedYes


  • Comorbidity
  • Liver Diseases
  • Liver Failure, Acute

ASJC Scopus subject areas

  • Transplantation


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