Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Feb;95(2):115-121.
doi: 10.1007/s00104-023-01992-w. Epub 2023 Nov 17.

[Transplantation for acute-on-chronic liver failure]

[Article in German]
F Becker  1 , J Trebicka  2 , P Houben  1 , A Pascher  3
Affiliations
Review

[Transplantation for acute-on-chronic liver failure]

[Article in German]
F Becker et al. Chirurgie (Heidelb). 2024 Feb.

Abstract
in English, German

A review and discussion of the current literature on liver transplantation for acute-on-chronic liver failure (ACLF) was performed. The ACLF represents an acute deterioration of liver function with pre-existing liver disease and is associated with increasing multiorgan failure, depending on the stage. The 28-day mortality ranges to well over 70% in stage 3 and requires rapid intensive medical treatment involving an interdisciplinary team experienced in transplantation medicine. Under optimized conditions, liver transplantation provides long-term survival rates comparable to other indications. Achieving this requires a differentiated donor selection, choosing the appropriate time for transplantation in the context of a dynamic disease course and the use of appropriate surgical techniques.

Es erfolgte eine Auswertung und Diskussion der aktuellen Literatur zur Lebertransplantation bei akut-auf-chronischem Leberversagen (ACLF). Das ACLF stellt eine akute Verschlechterung der Leberfunktion bei vorbestehender Lebererkrankung dar und geht, stadienabhängig, mit zunehmendem Multiorganversagen einher. Die 28-Tages-Mortalität reicht bis weit über 70 % im Stadium 3 und bedingt eine rasche intensivmedizinische Therapie unter Einbeziehung eines interdisziplinären, transplantationsmedizinisch erfahrenen Teams. Unter optimierten Bedingungen bietet die Lebertransplantation Langzeitüberlebensraten, die mit anderen Indikationen vergleichbar sind. Diese zu erreichen, setzt eine differenzierte Spenderauswahl, die Wahl des geeigneten Zeitpunktes zur Transplantation im Rahmen eines dynamischen Krankheitsverlaufes und die Anwendung geeigneter chirurgischer Techniken voraus.

Keywords: Donor selection; Liver transplantation; Model for end-stage liver disease; Multiorgan failure; Normothermic mechanical perfusion.

PubMed Disclaimer

References

Literatur

    1. Abdallah MA, Kuo YF, Asrani S et al (2021) Validating a novel score based on interaction between ACLF grade and MELD score to predict waitlist mortality. J Hepatol 74:1355–1361 - DOI - PubMed
    1. Artru F, Louvet A, Ruiz I et al (2017) Liver transplantation in the most severely ill cirrhotic patients: a multicenter study in acute-on-chronic liver failure grade 3. J Hepatol 67:708–715 - DOI - PubMed
    1. Artzner T, Belli LS, Faitot F et al (2023) Attitudes toward liver transplantation for ACLF‑3 determine equity of access. J Hepatol 78:e93–e95 - DOI - PubMed
    1. Artzner T, Michard B, Weiss E et al (2020) Liver transplantation for critically ill cirrhotic patients: stratifying utility based on pretransplant factors. Am J Transplant 20:2437–2448 - DOI - PubMed
    1. Belli LS, Duvoux C, Artzner T et al (2021) Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in europe: results of the ELITA/EF-CLIF collaborative study (ECLIS). J Hepatol 75:610–622 - DOI - PubMed

LinkOut - more resources