title: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014.
abstract: The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, "APASL ACLF Research Consortium (AARC)," was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here.
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. shivsarin@gmail.com.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Chandan Kumar
authors.initials: CK
authors.lastname: Kedarisetty
authors.affiliation: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
authors.forename: Zaigham
authors.initials: Z
authors.lastname: Abbas
authors.affiliation: Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research, Mumbai, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Amarapurkar
authors.affiliation: Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Chhagan
authors.initials: C
authors.lastname: Bihari
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Chan
authors.affiliation: Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Yogesh Kumar
authors.initials: YK
authors.lastname: Chawla
authors.affiliation: Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey.
authors.forename: A Kadir
authors.initials: AK
authors.lastname: Dokmeci
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Hitendra
authors.initials: H
authors.lastname: Garg
authors.affiliation: Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia.
authors.forename: Hasmik
authors.initials: H
authors.lastname: Ghazinyan
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Saeed
authors.initials: S
authors.lastname: Hamid
authors.affiliation: Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, Republic of Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
authors.forename: Piyawat
authors.initials: P
authors.lastname: Komolmit
authors.affiliation: Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Suman
authors.initials: S
authors.lastname: Lata
authors.affiliation: Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore.
authors.forename: Guan Huei
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Division of Hepatology, University of Indonesia, Jakarta, Indonesia.
authors.forename: Laurentius A
authors.initials: LA
authors.lastname: Lesmana
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Mamun
authors.initials: M
authors.lastname: Mahtab
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Rakhi
authors.initials: R
authors.lastname: Maiwall
authors.affiliation: Inserm, U1149, Centre de recherche sur l'Inflammation (CRI), Paris, France.|UMR_S 1149, Labex INFLAMEX, Université Paris Diderot Paris 7, Paris, France.|Département Hospitalo-Universitaire (DHU) UNITY, Service d'Hépatologie, Hôpital Beaujon, APHP, Clichy, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.affiliation: Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
authors.forename: Qin
authors.initials: Q
authors.lastname: Ning
authors.affiliation: Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Viniyendra
authors.initials: V
authors.lastname: Pamecha
authors.affiliation: Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines.
authors.forename: Diana Alcantara
authors.initials: DA
authors.lastname: Payawal
authors.affiliation: Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Archana
authors.initials: A
authors.lastname: Rastogi
authors.affiliation: Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
authors.forename: Salimur
authors.initials: S
authors.lastname: Rahman
authors.affiliation: Institute of Liver Diseases and Transplantation, Global Health City, Chennai, India.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Rela
authors.affiliation: Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Anoop
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authors.lastname: Saraya
authors.affiliation: INSERM, Centre Hépatobiliarie, Hôpital Paul Brousse, Villejuif, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.affiliation: Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Vivek
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authors.lastname: Saraswat
authors.affiliation: Department of Gastroenterology and Hepatology, Global Hospitals, Mumbai, India.
authors.forename: Samir
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authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt.
authors.forename: Gamal
authors.initials: G
authors.lastname: Shiha
authors.affiliation: Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
authors.forename: Brajesh Chander
authors.initials: BC
authors.lastname: Sharma
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Sharma
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Kapil
authors.initials: K
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
authors.forename: Amna Subhan
authors.initials: AS
authors.lastname: Butt
authors.affiliation: Department of Gastroenterology and Hepatology, Selayang Hospital, Kepong, Malaysia.
authors.forename: Soek Siam
authors.initials: SS
authors.lastname: Tan
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Chitranshu
authors.initials: C
authors.lastname: Vashishtha
authors.affiliation: Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
authors.forename: Zeeshan Ahmed
authors.initials: ZA
authors.lastname: Wani
authors.affiliation: Department of Medicine, The University of Hong Kong, Hong Kong, China.
authors.forename: Man-Fung
authors.initials: MF
authors.lastname: Yuen
authors.affiliation: Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Osamu
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authors.lastname: Yokosuka
keywords: Acute liver failure and Scute liver failure; Ascites; Chronic liver disease; Cirrhosis; Liver failure