Assessment and Management of the Liver Transplant Candidate with Acute‐on‐Chronic Liver Failure - Liver Transplantation - Wiley Online Library

Assessment and Management of the Liver Transplant Candidate with Acute-on-Chronic Liver Failure

Giovanni Perricone

Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK

Hepatology and Gastroenterology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy

Search for more papers by this author

Rajiv Jalan,

Rajiv Jalan

Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK

Search for more papers by this author

Giovanni Perricone,

Giovanni Perricone

Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK

Hepatology and Gastroenterology Unit, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy

Search for more papers by this author

Rajiv Jalan,

Rajiv Jalan

Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, UK

Search for more papers by this author

Book Editor(s):James Neuberger DM, FRCP,

James Neuberger DM, FRCP

Honorary Consultant Physician

Queen Elizabeth Hospital, Birmingham, UK

Search for more papers by this author

James Ferguson MD, FRCPE,

James Ferguson MD, FRCPE

Consultant Hepatologist

Queen Elizabeth Hospital and Hon Reader in Medicine, University of Birmingham, Birmingham, UK

Search for more papers by this author

Philip N. Newsome PhD, FRCPE,

Philip N. Newsome PhD, FRCPE

Professor of Experimental Hepatology and Director of the Centre for Liver and Gastrointestinal Research Consultant Transplant Hepatologist

University of Birmingham

Queen Elizabeth Hospital, Birmingham, UK

Search for more papers by this author

Michael Ronan Lucey MD, FRCPI,

Michael Ronan Lucey MD, FRCPI

Professor of Medicine and Chief

Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

Search for more papers by this author

First published: 12 March 2021

https://doi.org/10.1002/9781119634010.ch12

Summary

This chapter provides insights on the understanding of acute-on-chronic liver failure (ACLF), with emphasis on established diagnostic and prognostic criteria, and treatment/management options for transplant candidates. ACLF is a specific syndrome characterized by: acute deterioration of cirrhosis; failure of one or more organs; and high short-term mortality. ACLF is a major worldwide medical problem, with prevalence rates in at-risk populations in the region of 20-35%. The development of ACLF is associated with a precipitating factor. Patients with ACLF can be categorized according to the types of precipitating factors: hepatic or extrahepatic insults. Patients with hepatic ACLF and those with extrahepatic ACLF have different clinical phenotypes and prognosis. The accepted strategy for management of ACLF consists of early recognition and treatment of the precipitating event, and supportive care with intensive monitoring and support of failing organs. Liver transplantation represents the only definitive therapeutic option for patients with ACLF.

References

Arroyo V, Moreau R, Kamath PS, Jalan R, Ginès P, Nevens F, et al. Acute-on-chronic liver failure in cirrhosis. Nat Rev Dis Primers. 2016; 2: 16041.
10.1038/nrdp.2016.41
PubMed Web of Science® Google Scholar
Artru F, Louvet A, Ruiz I, Levesque E, Labreuche J, Ursic-Bedoya J, et al. Liver transplantation in the most severely ill cirrhotic patients: a multicenter study in acute-on-chronic liver failure grade 3. J Hepatol. 2017; 67(4): 708–715.
10.1016/j.jhep.2017.06.009
PubMed Web of Science® Google Scholar
Bhatti ABH, Dar FS, Butt MO, Sahaab E, Salih M, Shah NH, et al. Living donor liver transplantation for acute on chronic liver failure based on EASL-CLIF diagnostic criteria. J Clin Exp Hepatol. 2018; 8(2): 136–143.
10.1016/j.jceh.2017.11.007
PubMed Web of Science® Google Scholar
Engelmann C, Thomsen KL, Zakeri N, Sheikh M, Agarwal B, Jalan R, et al. Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support for patients with acute-on-chronic liver failure. Crit Care. 2018; 22(1): 254.
10.1186/s13054-018-2156-0
PubMed Web of Science® Google Scholar
Jalan R, Saliba F, Pavesi M, Amoros A, Moreau R, Ginès P, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol. 2014; 61(5): 1038–1047.
10.1016/j.jhep.2014.06.012
PubMed Web of Science® Google Scholar
Gustot T, Fernandez J, Garcia E, Morando F, Caraceni P, Alessandria C, et al. Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology. 2015; 62(1): 243–252.
10.1002/hep.27849
PubMed Web of Science® Google Scholar
Huebener P, Sterneck MR, Bangert K, Drolz A, Lohse AW, Kluge S, et al. Stabilisation of acute-on-chronic liver failure patients before liver transplantation predicts post-transplant survival. Aliment Pharmacol Ther. 2018; 47(11): 1502–1510.
10.1111/apt.14627
CAS PubMed Web of Science® Google Scholar
Levesque E, Winter A, Noorah Z, Daurès J-P, Landais P, Feray C, et al. Impact of acute-on-chronic liver failure on 90-day mortality following a first liver transplantation. Liver Int. 2017; 37(5): 684–693.
10.1111/liv.13355
PubMed Web of Science® Google Scholar
Moon DB, Lee S-G, Kang W-H, Song G-W, Jung D-H, Park G-C, et al. Adult living donor liver transplantation for acute-on-chronic liver failure in high–Model for End-Stage Liver Disease score patients. Am J Transplant. 2017; 17(7): 1833–1842.
10.1111/ajt.14198
PubMed Web of Science® Google Scholar
Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013; 144(7): 1426–1437, 1437.e1–9.
10.1053/j.gastro.2013.02.042
PubMed Web of Science® Google Scholar
Nadim MK, Durand F, Kellum JA, Levitsky J, O'Leary JG, Karvellas CJ, et al. Management of the critically ill patient with cirrhosis: a multidisciplinary perspective. J Hepatol. 2016; 64(3): 717–735.
10.1016/j.jhep.2015.10.019
PubMed Web of Science® Google Scholar
O'Leary JG, Bajaj JS, Tandon P, Biggins SW, Wong F, Kamath PS, et al. Outcomes after listing for liver transplant in patients with acute-on-chronic liver failure: the multicenter North American Consortium for the Study of End-Stage Liver Disease experience. Liver Transpl. 2019; 25(4): 571–579.
10.1002/lt.25426
PubMed Web of Science® Google Scholar
Sundaram V, Jalan R, Wu T, Volk ML, Asrani SK, Klein AS, et al. Factors associated with survival of patients with severe acute-on-chronic liver failure before and after liver transplantation. Gastroenterology. 2019; 156(5): 1381–1391.
10.1053/j.gastro.2018.12.007
PubMed Web of Science® Google Scholar
Sundaram V, Kogachi S, Wong RJ, Karvellas CJ, Fortune BE, Mahmud N, et al. Effect of the clinical course of acute-on-chronic liver failure prior to liver transplantation on post-transplant survival. J Hepatol. 2020; 72(3): 481–488.
10.1016/j.jhep.2019.10.013
PubMed Web of Science® Google Scholar
Thuluvath PJ, Thuluvath AJ, Hanish S, Savva Y. Liver transplantation in patients with multiple organ failures: feasibility and outcomes. J Hepatol. 2018; 69(5): 1047–1056.
10.1016/j.jhep.2018.07.007
PubMed Web of Science® Google Scholar
Yadav SK, Saraf N, Choudhary NS, Sah JK, Sah SK, Rastogi A, et al. Living donor liver transplantation for acute-on-chronic liver failure. Liver Transpl. 2019; 25(3): 459–468.
10.1002/lt.25395
PubMed Web of Science® Google Scholar

Liver Transplantation: Clinical Assessment and Management, Second Edition