Liver Transplantation for Acute on Chronic Liver Failure

J Clin Exp Hepatol. 2017 Sep;7(3):247-252. doi: 10.1016/j.jceh.2017.08.001. Epub 2017 Aug 24.


Background: Acute-on chronic liver failure (ACLF) is defined as acute insult on previous liver disease that causes sudden worsening of liver functions.

Methods: ACLF is characterized by high incidence of organ failure and prognosis is remarkably worse than patients with cirrhosis. Incidence of organ failures is very high despite best medical care and timely liver transplant before development of multi organ failure is associated with good survival rates.

Results: At present, there are no reliable score or ways to correctly identify patients who are going to recover from patients who will need transplantation. Organ failures are important part of prognosis and to define need or futility of early liver transplantation.

Conclusion: Asian Pacific Association for the Study of the Liver (APASL) published their recommendations regarding ACLF in 2014. Several important studies regarding course/nature of disease and transplantation for ACLF became available after 2014 APASL recommendations and still there are some unanswered areas. The current review discusses various issues regarding liver transplantation in patients with ACLF.

Keywords: ACLF, acute-on chronic liver failure; APASL, Asian Pacific Association for the Study of the Liver; DDLT, deceased donor liver transplantation; EASL, European Association for the Study of the Liver; India; LDLT, living donor liver transplantation; LT, liver transplantation; MELD, model for end stage liver disease; OFs, organ failures; SIRS, systemic inflammatory response syndrome; acute-on chronic liver failure; liver transplantation; living donor liver transplantation; survival.