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Review
. 2025 Mar;45(3):e15749.
doi: 10.1111/liv.15749. Epub 2023 Sep 27.

The clinical relevance of acute-on-chronic liver failure in medical procedures: Endoscopy, interventions and surgery

Michael Praktiknjo  1 , Debbie Shawcross  2 , Wim Laleman  1   3   4
Affiliations
Review

The clinical relevance of acute-on-chronic liver failure in medical procedures: Endoscopy, interventions and surgery

Michael Praktiknjo et al. Liver Int. 2025 Mar.

Abstract

Acute-on-chronic liver failure (ACLF) is a specific, but complex and multifactorial form of acute decompensation (AD) of cirrhosis and is characterized by an extraordinary dynamic natural course, rapidly evolving organ failure and high short-term mortality. In daily clinical practice, patients with liver cirrhosis and decompensation have indications for different medical procedures such as endoscopies, interventional treatments like transjugular intrahepatic portosystemic shunt (TIPS) or even surgical procedures. In these situations, clinicians often need to balance the expected benefits of such procedures with the risks of causing acute decompensation or ACLF. This review summarizes the evidence of medical procedures and their role in precipitating or preventing ACLF and highlights the aspects to consider during patient selection.

Keywords: TIPS; acute‐on‐chronic liver failure; cirrhosis‐associated immune dysfunction; endoscopy; surgery.

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Conflict of interest statement

All authors declare no conflict of interests.

Figures

FIGURE 1
FIGURE 1
Overview of the rates of ACLF in different medical procedures and its selected risk factors.
See this image and copyright information in PMC

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