ARTIFICIAL LIVER TREATMENT IMPROVES SURVIVAL IN PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE: A PROPENSITY SCORE-MATCHED ANALYSIS

Background: The artificial liver support system (ALSS) is recognized as a bridge to liver transplantation (LT) in hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) patients; however, its impact on patient survival remains unknown. This study aimed to assess the effects of ALSS on survival in patients with HBV-ACLF. Methods: The clinical data of HBV-ACLF patients receiving standard medical treatment (SMT) plus ALSS (ALSS group, n = 507) or only SMT (SMT group, n = 417) were collected for survival assessment. The main endpoints were cumulative survival rates at days 21, 28 and 90. A case-control matched analysis was used to reduce bias between the ALSS and SMT groups. A propensity score matching (PSM) and inverse probability treatment weighting (IPTW) analysis were performed to confirm the survival effect of ALSS. Findings: In the entire cohort, the cumulative survival rates at days 21, 28 and 90 were significantly higher in patients who underwent ALSS treatment (73.3% vs. 59.6%, 69.2% vs. 56.6%, 56.5% vs. 49.1%, respectively, P <0.01) than in those who underwent SMT only. In the 276-pair case-control matched cohort, a significantly higher survival rate was also observed in the ALSS group than in the SMT group on days 21, 28 and 90 (72.5% vs. 60.3%, 68.3% vs. 57.4%, 55.9% vs. 48.5%, respectively, P <0.05), especially in patients with ACLF-1 and -2. By a multivariable-adjusted analysis, ALSS treatment was associated with a significantly lower risk of mortality, especially for ACLF-2 at days 21, 28 and 90 (HR: 0.587, 0.596 and 0.640, respectively). These findings were also confirmed through PSM and IPTW analysis (HR: 0.482/0.538 and 0.538/0.552 at day 21/28, respectively, P <0.01). Interpretation: Compared with SMT, ALSS treatment improved the short-term survival and was associated with a significantly lower risk of short-term mortality in patients with HBV-ACLF, especially ACLF-2. Funding Statement: The authors declared: None. Declaration of Interests: The authors stated: No conflict. Ethics Approval Statement: The study protocol was approved by the Clinical Research Ethics Committee of the First Affiliated Hospital, Zhejiang University School of Medicine (No. 2011-13). All patients were well informed, and written consent was obtained from the study subjects or the legal surrogates of patients before enrolment.