Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)

Abstract

The Asian Pacific Association for the Study of the Liver (APASL) set up a working party on acute-on-chronic liver failure (ACLF) in 2004, with a mandate to develop consensus guidelines on various aspects of ACLF relevant to disease patterns and clinical practice in the Asia-Pacific region. Experts predominantly from the Asia-Pacific region constituted this working party and were requested to identify different issues of ACLF and develop the consensus guidelines. A 2-day meeting of the working party was held on January 22-23, 2008, at New Delhi, India, to discuss and finalize the consensus statements. Only those statements that were unanimously approved by the experts were accepted. These statements were circulated to all the experts and subsequently presented at the Annual Conference of the APASL at Seoul, Korea, in March 2008. The consensus statements along with relevant background information are presented in this review.

Fig. 1

Contentious issues in acute-on-chronic liver failure

Fig. 2

Various definitions of acute and acute-on-chronic liver failure

Fig. 3

Degree of acute and chronic insult in acute-on-chronic liver failure (ACLF): Two scenarios. The first artwork shows a patient with mild chronic liver disease but severe acute liver insult leading to ACLF. The second artwork shows a patient with moderate chronic liver disease and less severe acute insult. The resulting severity of ACLF is same in these two situations