ORIGINAL RESEARCH
Transpl. Int.
Trends in Liver Transplantation for Acute Liver Failure in a Spanish Multicenter Cohort
- IC
Isabel Conde Amiel 1,2,3
- SM
Sara Martínez Delgado 1
- AB
Andrea Bosca Robledo 1,2
- MS
María Senosiáin Labiano 4
- RM
Rosa María Martín Mateos 5,3
- CA
Carolina Almohalla Álvarez 6
- ML
María Luisa González Diéguez 7
- SL
Sara Lorente Pérez 8
- AO
Alejandra Otero Ferreiro 9
- MR
María Rodríguez-Soler 10
- JI
Jose Ignacio Herrero 11,12,3
- LA
Laia Aceituno 13,14
- AF
Ainhoa Fernández Yunquera 15
- MB
Marina Berenguer 1,2,3,16
- VA
Victoria Aguilera 1,2,3,16
1. Hospital Universitari i Politecnic La Fe, Valencia, Spain
2. Instituto de Investigacion Sanitaria La Fe, Valencia, Spain
3. Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas, Madrid, Spain
4. Hospital Universitario Cruces, Barakaldo, Spain
5. Hospital Universitario Ramon y Cajal, Madrid, Spain
6. Hospital Universitario Rio Hortega, Valladolid, Spain
7. Hospital Universitario Central de Asturias, Oviedo, Spain
8. Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain
9. Complexo Hospitalario Universitario A Coruna, A Coruña, Spain
10. Hospital General Universitario Dr Balmis, Alicante, Spain
11. Clinica Universidad de Navarra, Pamplona, Spain
12. Instituto de Investigacion Sanitaria de Navarra, Pamplona, Spain
13. Hospital Universitari Vall d'Hebron, Barcelona, Spain
14. Toronto General Hospital, Toronto, Canada
15. Hospital General Universitario Gregorio Maranon, Madrid, Spain
16. Universitat de Valencia, Valencia, Spain
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Abstract
Background & Aims: Acute 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. Methods: We 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. Results: 217 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. The study revealed temporal changes with a greater prevalence of autoimmune and drug-induced liver injury (despite decreasing relevance of acetaminophen toxicity), and a decrease in hepatitis B virus. Infections post-LT increased, likely due to stronger immunosuppression in recent years. Other post-LT complications (respiratory insufficiency, chronic kidney disease, cardiovascular events) and mortality were reduced. 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.
Summary
Keywords
liver transplantation, Outcomes, acute liver failure, aetiology, sex differences
Received
27 June 2025
Accepted
24 November 2025
Copyright
© 2025 Conde Amiel, Martínez Delgado, Bosca Robledo, Senosiáin Labiano, Martín Mateos, Almohalla Álvarez, González Diéguez, Lorente Pérez, Otero Ferreiro, Rodríguez-Soler, Herrero, Aceituno, Fernández Yunquera, Berenguer and Aguilera. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Isabel Conde Amiel, icondemiel@gmail.com
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