Predictors of Mortality After Liver Transplantation for Acute Liver Failure: A Multicenter Cohort Study.

INTRODUCTION: Acute liver failure (ALF) is a rare and life-threatening condition characterized by rapid deterioration of liver function and often requires urgent liver transplantation (LT). This study aimed to evaluate donor and recipient factors associated with 30-day mortality after LT for ALF. METHODS: Medical records of patients who underwent LT for ALF at seven Brazilian transplant centers were reviewed. Patient data were obtained from electronic medical records. The primary outcome was 30-day mortality after LT. RESULTS: Ninety patients who underwent LT for ALF were included. Thirty-day mortality occurred in 46 of 90 patients (51%). In multivariable analysis, higher pretransplant serum creatinine levels (OR 3.49, 95% CI 1.69-8.72; p = 0.003) and the need for mechanical ventilation prior to transplantation (OR 5.46, 95% CI 1.21-28.9; p = 0.033) were independently associated with early mortality. Donor age ≥ 50 years and pretransplant vasoactive drug use were associated with mortality in univariate analysis. CONCLUSION: Higher pretransplant serum creatinine levels and the need for mechanical ventilation were independently associated with 30-day mortality, whereas donor age ≥ 50 years and pretransplant vasoactive drug use were associated with mortality only in the univariate analysis. These findings support improved pretransplant risk stratification and perioperative management in patients undergoing LT for ALF.