title: Bench-to-beside review: acute-on-chronic liver failure - linking the gut, liver and systemic circulation.
abstract: The concept of acute-on-chronic liver failure (ACLF) was introduced recently to describe a subset of patients with chronic liver disease presenting with profound deterioration of liver function and rapidly evolving multi-organ failure. ACLF is frequently accompanied by the development of severe inflammatory response syndrome and has a high mortality. To date, treatment options are limited and exclusively supportive. Over the last few years, some insights have been generated in the pathophysiology of ACLF. A key role for the interaction of innate immune dysfunction, enhanced bacterial translocation from the gut, and circulatory dysfunction has been proposed. In this respect, therapeutic strategies have been examined, with variable success, in experimental studies in animals and humans. This review focuses on potentially relevant pathophysiological elements in the development of ACLF and points out promising treatment modalities in ACLF.
authors: Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, KU Leuven, Herestraat 49, B-3000 Leuven, Belgium. Len.verbeke@med.kuleuven.be
authors: Len
authors: L
authors: Verbeke
authors: Frederik
authors: F
authors: Nevens
authors: Wim
authors: W
authors: Laleman
mesh_terms: D018988:Bacterial Translocation; D058625:End Stage Liver Disease / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D041981:Gastrointestinal Tract / Q000382:microbiology; D006801:Humans; D007113:Immunity, Innate; D008099:Liver / Q000098:blood supply; D017114:Liver Failure, Acute / Q000276:immunology / Q000503:physiopathology / Q000628:therapy; D008833:Microcirculation