ACLF and Liver Transplantation

AbstractPurpose of reviewThe prevalence, mechanisms, and outcomes of acute-on-chronic liver failure (ACLF) pretransplant that affect post-transplant results are herein summarized.Recent findingsACLF, defined by organ failures, continues to increase in incidence and now affects almost a quarter of patients before liver transplant. MELD-lactate has emerged as a useful tool to predict inpatient mortality in ACLF patients. ACLF is characterized by bioenergetic failure and increased immunologic response. Specific stool microbiome and serum metabolomic signatures on admission can help predict who is at greatest risk for ACLF pretransplant. Known pretransplant risk factors in patients with ACLF for post-transplant death, such as ongoing respiratory failure, are discussed.SummaryHighly selected patients with 1-2 organ failures pretransplant seem to have equivalent post-transplant outcomes to those transplanted without organ failures. However, patients with three or more organ failures, especially those with ongoing respiratory failure at transplant, have an increased risk for death post-transplant.
Source: Current Treatment Options in Gastroenterology - Category: Gastroenterology Source Type: research