Transplantation for Acute‐on‐Chronic Liver Failure
Tiffany Wu, M.D., Department of Internal Medicine, Cedars‐Sinai Medical Center, 8700 Beverly Blvd., B‐220, Los Angeles, CA 90048. E‐mail: moc.liamg@8uwynaffit,
Abbreviations
- ACLF
- acute‐on‐chronic liver failure
- CLIF
- chronic liver failure
- EASL‐CLIF
- European Association for the Study of the Liver–chronic liver failure
- ICU
- intensive care unit
- LT
- liver transplantation
- MELD‐Na
- Model for End‐Stage Liver Disease–Sodium
- N/A
- not available
- SOFA
- sequential organ failure assessment
- UNOS
- United Network for Organ Sharing
Acute‐on‐chronic liver failure (ACLF) is a syndrome defined by acute hepatic decompensation of known cirrhosis and resultant extrahepatic organ failures, and is characterized by a systemic inflammatory response.1, 2, 3 Identification of ACLF is based on the study by the European Association for the Study of the Liver–chronic liver failure (EASL‐CLIF) Consortium called the EASL‐CLIF Acute‐on‐Chronic Liver Failure in Cirrhosis (CANONIC) study, which proposed a diagnostic scoring system and evaluated six different organ systems (liver, kidney, brain, coagulation, circulation, and respiration) for prognostication. Definition of organ failure uses a modified sequential organ failure assessment (SOFA) score called CLIF‐SOFA. ACLF is further categorized based on number of organ failures, with the most severe category, ACLF‐3 (defined as three or more organ failures), reaching 28‐ and 90‐day transplant‐free mortality rates of 76.7% and 79.1%, respectively.1 ACLF is rapidly progressive and portends poor prognosis without transplantation. Liver transplantation (LT) may dramatically improve survival among patients with ACLF‐3.4, 5, 6 However, gaps in our knowledge remain regarding priority on the wait list and futility for transplantation among patients with multiorgan failure.
Notes
Potential conflict of interest: Nothing to report.
References
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