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Is Fulminant Hepatic Failure the Nemesis of Liver Transplantation at TGH? A Two Decade Psycho-Social and Long-Term Outcomes Study
Poster Title: Is Fulminant Hepatic Failure the Nemesis of Liver Transplantation at TGH? A Two Decade Psycho-Social and Long-Term Outcomes Study
Submitted on 02 Aug 2018
Author(s): Pamela Bulu, Alexa Alsina, Angel Alsina MD, Alexia Athienitis PhD, Edson Franco MD, John Leone MD PhD, Victor Bowers MD, Brenna Evans RN, Jacentha Buggs MD, Mark Rumbak MD, Nyingi Kemmer MD
Affiliations: University of South Florida, Tampa General Hospital
This poster was presented at USF Research Day 2018
Poster Views: 418
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Abstract: Liver transplantation (LTx) for acute liver failure (ALF) has a high early mortality rate. Psycho-social aspects of ALF are not well-studied. No study has followed patients long-term.

From 1997-2017, 47 LTx patients with ALF were identified. Twelve of these patients died within 3 months of LTx, and were excluded. Data was collected from hospital charts, outpatient charts, transplant flowcharts, psychological evaluations, transplant coordinators interviews, UNOS, and EMR. Data collected includes demographics, psychological characteristics, clinical characteristics, life stressors, adherence, and causes of death. Data was analyzed using Kaplan-Meir (KM), Fisher’s Exact Test, Chi-square, Wilcoxon Rank Sum, and Mantel-Haenszel using SAS 9.4.

Four of 11 (36%) patients who practiced poor adherence died of related complications. No patients that practiced fair or good adherence died from non-adherence. Twenty-nine of 35 patients are currently alive. Factors affecting adherence include inability to participate in transplant decision, financial stress, and lack of parental presence. KM 5-year survival of patients with poor adherence post-LTx was 78% vs fair adherence (83%) and good adherence (100%). Survival was associated with ability to participate in transplant decision, education, insurance, and ethnicity. Using Log Rank, patients participating in transplant decision had 80% 5-year survival rate vs 61% for those who did not participate.

Early mortality and fatal complications related to poor adherence plague LTx programs. Psycho-social factors and life stressors did affect adherence and survival. Pre-transplant characteristics correlated with poor results could aid in selecting LTx candidates. No improvement of ALF LTx was observed over 20 years.
Summary: This study follows post-acute liver failure transplant recipients for 20 years to identify psycho-social factors linked to adherence and survival. References: Trey C, Davidson C. The management of fulminant hepatic failure. Prog Liver Dis 1970;3:282-98.
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