title: Liver transplantation in acute on chronic liver failure: challenges and an algorithm for patient selection and management.
abstract: Acute on chronic liver failure is an entity distinct from acute liver failure and acute decompensation of chronic liver disease. Despite best medical therapy, it is associated with high short-term mortality due to infection and organ failure. Liver transplantation is a potentially curative treatment option that has been shown to have good outcomes in this setting. As there are no reliable ways of predicting which subset of patients will recover spontaneously, early transplantation before establishment of full blown sepsis or organ failure is expected to have favorable outcomes with an acceptable risk. This article reviews current literature on liver transplantation for acute on chronic liver failure, discusses challenges in patient selection, and proposes an algorithm for management.
authors.affiliation: Department of Liver Transplantation & HPB Surgery, Institute of Liver and Biliary Sciences, New Delhi, India. viniyendra@yahoo.co.uk.
authors.forename: Viniyendra
authors.initials: V
authors.lastname: Pamecha
authors.affiliation: Department of Liver Transplantation & HPB Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Senthil
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Liver Transplantation & HPB Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Kishore G S
authors.initials: KG
authors.lastname: Bharathy
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000401:mortality / Q000601:surgery*; D000465:Algorithms; D019468:Disease Management; D014943:Global Health; D006801:Humans; D016031:Liver Transplantation / Q000379:methods*; D018579:Patient Selection; D011379:Prognosis; D015996:Survival Rate / Q000639:trends
keywords: Acute on chronic liver failure; Liver transplantation; Management; Survival