Acute-on-Chronic Liver Failure: Getting Ready for Prime Time?

Jasmohan S. Bajaj, Richard Moreau, Patrick Sequeira Kamath, Hugo E Vargas, Vicente Arroyo, K. Rajender Reddy, Gyongyi Szabo, Puneeta Tandon, Jody Olson, Constantine Karvellas, Thierry Gustot, Jennifer C. Lai, Florence Wong

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Acute on chronic liver failure (ACLF) is the culmination of chronic liver disease and extrahepatic organ failures, which is associated with a high short-term mortality and immense health care expenditure. There are varying definitions for organ failures and ACLF in Europe, North America, and Asia. These differing definitions need to be reconciled to enhance progress in the field. The pathogenesis of ACLF is multifactorial and related to interactions between the immunoinflammatory system, microbiota, and the various precipitating factors. Individual organ failures related to the kidney, brain, lungs, and circulation have cumulative adverse effects on mortality and are often complicated or precipitated by infections. Strategies to prevent and rapidly treat these organ failures are paramount in improving survival. With the aging population and paucity of organs for liver transplant, the prognosis of ACLF patients is poor, highlighting the need for novel therapeutic strategies. The role of liver transplant in ACLF is evolving and needs further investigation across large consortia. A role for early palliative care and management of frailty as approaches to alleviate disease burden and improve patient-reported outcomes is being increasingly recognized. Conclusion: ACLF is a clinically relevant syndrome that is epidemic worldwide and requires a dedicated multinational approach focused on prognostication and management; investigations are underway worldwide to prepare ACLF for prime time.(Hepatology 2018; 00:000-000).

Original languageEnglish (US)
JournalHepatology
DOIs
StateAccepted/In press - Jan 1 2018

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Northern Asia
Transplants
Precipitating Factors
Mortality
Liver
Microbiota
Gastroenterology
Health Expenditures
North America
Acute-On-Chronic Liver Failure
Palliative Care
Liver Diseases
Chronic Disease
Delivery of Health Care
Kidney
Lung
Survival
Brain
Infection
Population

ASJC Scopus subject areas

  • Hepatology

Cite this

Acute-on-Chronic Liver Failure : Getting Ready for Prime Time? / Bajaj, Jasmohan S.; Moreau, Richard; Kamath, Patrick Sequeira; Vargas, Hugo E; Arroyo, Vicente; Reddy, K. Rajender; Szabo, Gyongyi; Tandon, Puneeta; Olson, Jody; Karvellas, Constantine; Gustot, Thierry; Lai, Jennifer C.; Wong, Florence.

In: Hepatology, 01.01.2018.

Research output: Contribution to journalArticle

Bajaj, JS, Moreau, R, Kamath, PS, Vargas, HE, Arroyo, V, Reddy, KR, Szabo, G, Tandon, P, Olson, J, Karvellas, C, Gustot, T, Lai, JC & Wong, F 2018, 'Acute-on-Chronic Liver Failure: Getting Ready for Prime Time?', Hepatology. https://doi.org/10.1002/hep.30056
Bajaj, Jasmohan S. ; Moreau, Richard ; Kamath, Patrick Sequeira ; Vargas, Hugo E ; Arroyo, Vicente ; Reddy, K. Rajender ; Szabo, Gyongyi ; Tandon, Puneeta ; Olson, Jody ; Karvellas, Constantine ; Gustot, Thierry ; Lai, Jennifer C. ; Wong, Florence. / Acute-on-Chronic Liver Failure : Getting Ready for Prime Time?. In: Hepatology. 2018.
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