Liver Transplantation at the Extreme: Analysis of Outcomes and Predictors of Futility in Acute-on-Chronic Liver Failure Grade 3 Patients on Maximal Life Support.

Of 1,608 adult liver transplant recipients at our center, 177 (11%) were eACLF-3.

Thirty-five (20%) eACLF-3 recipients experienced futility.

Predictors of futility were previous upper abdominal surgery (OR=4.6, P=0.002), sepsis within 14 days prior to liver transplant (OR= 5.9, P= 0.013), intubation due to pneumonia or acute respiratory distress syndrome (OR= 3.5, P= 0.010), worsening PaO2:FiO2 ratio (OR= 3.9, P=0.008), and pre-liver transplant base deficit (OR=1.27, P=0.007).