AUTHOR=Conde Amiel Isabel , Martínez Delgado Sara , Bosca Robledo Andrea , Senosiáin Labiano María , Martín Mateos Rosa María , Almohalla Álvarez Carolina , González Diéguez María Luisa , Lorente Pérez Sara , Otero Ferreiro Alejandra , Rodríguez-Soler María , Herrero José Ignacio , Aceituno Laia , Fernández Yunquera Ainhoa , Berenguer Marina , Aguilera Sancho-Tello Victoria 

TITLE=Trends in Liver Transplantation for Acute Liver Failure in a Spanish Multicenter Cohort

JOURNAL=Transplant International

VOLUME=Volume 38 - 2025

YEAR=2025

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.15185

DOI=10.3389/ti.2025.15185

ISSN=1432-2277

ABSTRACT=Background and AimsAcute liver failure (ALF) is a rare and severe condition with high mortality. Liver transplantation (LT) has improved patient outcomes. This study analysed trends in aetiology, characteristics, and outcomes of ALF patients undergoing LT in Spain.MethodsWe retrospectively reviewed 217 adult ALF-LT cases from 11 Spanish centers (2001 -2020), divided into two 10-year periods. Clinical, biochemical, and outcome data were collected, and predictors of mortality were identified.Results217 adult ALF-LT patients were included (61.8% women, mean age: 41 years). Common aetiologies were cryptogenic (26.7%), autoimmune (26.3%), and viral (18%), with sex differences. Over time, autoimmune and drug-induced liver injury increased (22.3% vs 29.8% and 13.6% vs 21.1%), with a low prevalence of acetaminophen toxicity, and hepatitis B virus declined (23.3% vs 11.4%). Despite higher infection rates (52.5% vs 66.2%) linked to stronger immunosuppression, respiratory failure (29.1% vs 16.1%), chronic kidney disease (27.1% vs 13.6%), cardiovascular events (10.6% vs 1%), and mortality (37.6% vs 17.9%) decreased. Pre-LT hypertension, pre-LT acute kidney injury, and hypernatremia at LT were independently associated with worse survival. This large multicenter study revealed temporal changes in aetiologies, immunosuppressive treatment, and post-LT complications, with an improvement in outcome.