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. 2014 Oct;8(4):453-71.
doi: 10.1007/s12072-014-9580-2. Epub 2014 Sep 26.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Shiv Kumar Sarin  1 , Chandan Kumar Kedarisetty  2 , Zaigham Abbas  3 , Deepak Amarapurkar  4 , Chhagan Bihari  5 , Albert C Chan  6 , Yogesh Kumar Chawla  7 , A Kadir Dokmeci  8 , Hitendra Garg  2 , Hasmik Ghazinyan  9 , Saeed Hamid  10 , Dong Joon Kim  11 , Piyawat Komolmit  12 , Suman Lata  13 , Guan Huei Lee  14 , Laurentius A Lesmana  15 , Mamun Mahtab  16 , Rakhi Maiwall  2 , Richard Moreau  17   18   19 , Qin Ning  20 , Viniyendra Pamecha  21 , Diana Alcantara Payawal  22 , Archana Rastogi  5 , Salimur Rahman  16 , Mohamed Rela  23 , Anoop Saraya  24 , Didier Samuel  25 , Vivek Saraswat  26 , Samir Shah  27 , Gamal Shiha  28 , Brajesh Chander Sharma  29 , Manoj Kumar Sharma  2 , Kapil Sharma  2 , Amna Subhan Butt  10 , Soek Siam Tan  30 , Chitranshu Vashishtha  2 , Zeeshan Ahmed Wani  2 , Man-Fung Yuen  31 , Osamu Yokosuka  32 ; APASL ACLF Working Party
Affiliations

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Shiv Kumar Sarin et al. Hepatol Int. 2014 Oct.

Erratum in

  • Correction: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014.
    Sarin SK, Kedarisetty CK, Abbas Z, Amarapurkar D, Bihari C, Chan ACY, Chawla YK, Dokmeci AK, Garg H, Ghazinyan H, Hamid S, Kim DJ, Komolmit P, Lata S, Lee GH, Lesmana LA, Mahtab M, Maiwall R, Moreau R, Ning Q, Pamecha V, Payawal DA, Rastogi A, Rahman S, Rela M, Saraya A, Samuel D, Saraswat V, Shah S, Shiha G, Sharma BC, Sharma MK, Sharma K, Butt AS, Tan SS, Vashishtha C, Wani ZA, Yuen MF, Yokosuka O; APASL ACLF Working Party. Sarin SK, et al. Hepatol Int. 2025 Jul 31. doi: 10.1007/s12072-025-10858-8. Online ahead of print. Hepatol Int. 2025. PMID: 40742661 No abstract available.

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.

Keywords: Acute liver failure and Scute liver failure; Ascites; Chronic liver disease; Cirrhosis; Liver failure.

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