Long-term outcomes and temporal trends following liver transplantation for chronic liver disease in the intensive care unit

Background and Aims Liver transplantation (LT) remains the definitive treatment for patients with end-stage chronic liver disease (CLD). However, those transplanted while in intensive care unit (ICU) represent a high-risk population. Large-scale data on long-term prognosis in this group are limited. We aimed to assess long-term outcomes in CLD patients undergoing LT from the ICU and to compare outcomes over time. Methods This retrospective cohort study used the French national transplant registry (CRISTAL). Adults with CLD who underwent LT from the ICU between 2008 and 2018 were included. Organ failures were defined according to EASL CLIF-OF criteria. Five-year survival and associated risk factors were analyzed and compared across four time periods (2008–2010, 2011–2013, 2014–2016, 2017–2018). Results Among 13,372 LTs performed in France during the study period, 9,686 were for CLD, of whom 1,287 (13.2%) were in the ICU at the time of LT. Alcohol-related liver disease (50%) and viral hepatitis (16.1%) were the leading etiologies. Five-year survival was significantly lower in CLD-ICU patients compared to non-ICU patients (69.2% vs. 79.1%, p