Trebicka, J; Sundaram, V; Moreau, R; Jalan, R; Arroyo, V; (2020) Liver transplantation for Acute‐on‐Chronic Liver Failure: Science or fiction? Liver Transplantation , 26 (7) pp. 906-915. 10.1002/lt.25788.

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Abstract

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, is an important event determining a crossroad in the trajectory of patients. A significant number of patients with acute decompensation may develop hepatic or extrahepatic organ failure, or both, which defines the syndrome named acute‐on‐chronic liver failure (ACLF), which 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 liver transplantation, and possible indicators of futility. Importantly, prospective studies on ACLF and transplantation are urgently needed.

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