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Liver Transplantation for Acute‐on‐Chronic Liver Failure: Science or Fiction?
Author(s) -
Trebicka Jonel,
Sundaram Vinay,
Moreau Richard,
Jalan Rajiv,
Arroyo Vicente
Publication year - 2020
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.25788
Subject(s) - medicine , liver transplantation , decompensation , cirrhosis , chronic liver disease , intensive care medicine , transplantation , liver disease , liver failure , disease , gastroenterology
Acute clinical deterioration of a patient with chronic liver disease remains a decisive time point both in terms of medical management and prognosis. This condition, also known as acute decompensation (AD), is an important event determining a crossroad in the trajectory of patients. A significant number of patients with AD may develop hepatic or extrahepatic organ failure, or both, which defines the syndrome acute‐on‐chronic liver failure (ACLF), and ACLF is associated with a high morbidity and short‐term mortality. ACLF may occur at any phase during chronic liver disease and is pathogenetically defined by systemic inflammation and immune metabolic dysfunction. When organ failures develop in the presence of cirrhosis, especially extrahepatic organ failures, liver transplantation (LT) may be the only curative treatment. This review outlines the evidence supporting LT in ACLF patients, highlighting the role of timing, bridging to LT, and possible indicators of futility. Importantly, prospective studies on ACLF and transplantation are urgently needed.