title: New concepts in acute-on-chronic liver failure: Implications for liver transplantation.
abstract: Acute-on-chronic liver failure (ACLF) is a recently defined syndrome that occurs frequently in patients with cirrhosis and is associated with a poor short-term prognosis. Currently, management of patients with ACLF is mainly supportive. Despite medical progress, this syndrome frequently leads to multiorgan failure, sepsis, and, ultimately, death. The results of attempts to use liver transplantation (LT) to manage this critical condition have been poorly reported but are promising. Currently, selection criteria of ACLF patients for LT, instructions for prioritization on the waiting list, and objective indicators for removal of ACLF patients from the waiting list in cases of clinical deterioration are poorly defined. Before potential changes can be implemented into decisional algorithms, their effects, either on the benefits to individual patients or on global transplant outcomes, should be carefully evaluated using objective longterm endpoints that take into account ethical considerations concerning LT. Liver Transplantation 23 234-243 2017 AASLD.
authors.affiliation: Department of Gastroenterology and Hepato-Pancreatology, C.U.B. Erasme Hospital, Brussels, Belgium.
authors.forename: Antonella
authors.initials: A
authors.lastname: Putignano
authors.affiliation: Department of Gastroenterology and Hepato-Pancreatology, C.U.B. Erasme Hospital, Brussels, Belgium.|Laboratory of Experimental Gastroenterology, Université Libre de Bruxelles, Brussels, Belgium.|INSERM Unité 1149, Centre de Recherche sur l'inflammation, Paris, France.|Unités Mixtes de Recherche en Santé 1149, Université Paris Diderot, Paris, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustot
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D058625:End Stage Liver Disease / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation / Q000941:ethics* / Q000592:standards; D009102:Multiple Organ Failure / Q000209:etiology*; D018579:Patient Selection / Q000941:ethics; D015995:Prevalence; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000592:standards; D014850:Waiting Lists / Q000401:mortality