Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 27, 2023 Category: Gastroenterology Source Type: research
Contents
Nikolaos T. Pyrsopoulos (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 27, 2023 Category: Gastroenterology Source Type: research
Forthcoming Issues
Hepatitis B Virus and Hepatitis D Virus (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - June 27, 2023 Category: Gastroenterology Source Type: research
Hepatic Encephalopathy in Acute-on-Chronic Liver Failure
Acute-on-chronic liver failure (ACLF) is characterized by the presence of chronic liver disease and extrahepatic organ failure and is associated with a high rate of short-term mortality. International societies have sought to define the criteria for ACLF and differ on definitions. Encephalopathy is an important organ failure in ACLF cases and is included as a marker of ACLF across society definitions. Both brain failure and ACLF commonly occur in the presence of a triggering event and in the setting of the large amount of inflammation that ensues. The presence of encephalopathy as a part of ACLF not only increases the chan...
Source: Clinics in Liver Disease - May 3, 2023 Category: Gastroenterology Authors: Bryan D. Badal, Jasmohan S. Bajaj Source Type: research
Mechanisms of Disease and Multisystemic Involvement
This article describes the proposed pathophysiologic mechanisms believed to be contributing and driving ACLF. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 28, 2023 Category: Gastroenterology Authors: Kamal Amer, Ben Flikshteyn, Vivek Lingiah, Zaid Tafesh, Nikolaos T. Pyrsopoulos Source Type: research
Maximizing the Donor Potential for Patients with Acute-on-Chronic Liver Failure Listed for Liver Transplant
Owing to inherent limitations of static cold storage, marginal liver grafts from donors after circulatory death and extended criteria donors after brain death are prone to be discarded secondary to the increased risk of severe early allograft dysfunction and ischemic cholangiopathy. Marginal liver grafts resuscitated with hypothermic machine perfusion and normothermic machine perfusion demonstrate lower degree of ischemia-reperfusion injury and have decreased risk of severe early allograft dysfunction and ischemic cholangiopathy. Marginal grafts preserved by ex vivo machine perfusion technology can be used to rescue pati...
Source: Clinics in Liver Disease - April 27, 2023 Category: Gastroenterology Authors: Arpit Amin, Guergana G. Panayotova, James V. Guarrera Source Type: research
Future Approaches and Therapeutic Modalities for Acute-on-Chronic Liver Failure
Acute-on-chronic liver failure (ACLF) results from an acute decompensation of cirrhosis due to exogenous insult. The condition is characterized by a severe systemic inflammatory response, inappropriate compensatory anti-inflammatory response, multisystem extrahepatic organ failure, and high short-term mortality. Here, the authors evaluate the current status of potential treatments for ACLF and assess their efficacy and therapeutic potential. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 27, 2023 Category: Gastroenterology Authors: Ali Wakil, Mumtaz Niazi, Keri E. Lunsford, Nikolaos Pyrsopoulos Source Type: research
Management of Portal Hypertension in Patients with Acute-on-Chronic Liver Disease
Portal hypertension is central to the pathogenesis of complications of cirrhosis, including acute-on-chronic liver failure (ACLF). Both nonselective beta-blockers and preemptive transjugular portal-systemic stent shunt can lower portal pressure, reducing the risk of variceal bleeding, a known trigger for ACLF. However, in patients with advanced cirrhosis, both could potentially induce ACLF by causing hemodynamic instability and hepatic ischemia, respectively, and therefore must be used with caution. Lowering portal pressure with vasoconstrictor such as terlipressin can reverse the kidney failure but careful patient selecti...
Source: Clinics in Liver Disease - April 26, 2023 Category: Gastroenterology Authors: Florence Wong Source Type: research
Acute on Chronic Liver Failure in Patients with Alcohol-Associated Hepatitis
Acute on chronic liver failure (ACLF) is a unique disease process associated with significant short-term mortality wherein patients with either chronic liver disease or cirrhosis suffer rapid decompensation in hepatic function accompanied by extrahepatic organ failures. Alcohol-associated hepatitis (AH) is a common precipitant of ACLF and has been shown to uniquely affect the pathophysiology of systemic and hepatic immune responses in patients with ACLF. Treatment of AH-associated ACLF includes supportive measures as well as treatment directed at AH; however, AH-directed therapies unfortunately remain limited and are of su...
Source: Clinics in Liver Disease - April 24, 2023 Category: Gastroenterology Authors: Camille A. Kezer, Douglas A. Simonetto, Vijay H. Shah Source Type: research
Classification and Epidemiologic Aspects of Acute-on-Chronic Liver Failure
The three most common definitions of acute-on-chronic liver failure (ACLF) are derived from data from North America, Europe, and the Asian-Pacific Region. All three definitions identify patients with underlying liver disease who are at increased risk for mortality who develop a syndrome often characterized by associated organ failures. The epidemiology of ACLF differs throughout various regions globally and is driven by the cause of the underlying chronic liver disease and the triggers of ACLF. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Zaid H. Tafesh, Raquel Olivo Salcedo, Nikolaos Pyrsopoulos Source Type: research
Pathology of Acute and Acute-on-Chronic Liver Failure
This article will discuss the pathologic features of acute and acute-on-chronic liver failure. Developing an appreciation for the histopathologic patterns of injury observed in these entities is essential for a practical understanding of the diagnostic process. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Cameron Beech, Chen Liu, Xuchen Zhang Source Type: research
Liver Regeneration in Acute on Chronic Liver Failure
Liver regeneration is a multifaceted process by which the organ regains its original size and histologic organization. In recent decades, substantial advances have been made in our understanding of the mechanisms underlying regeneration following loss of hepatic mass. Liver regeneration in acute liver failure possesses several classic pathways, while also exhibiting unique differences in key processes such as the roles of differentiated cells and stem cell analogs. Here we summarize these unique differences and new molecular mechanisms involving the gut –liver axis, immunomodulation, and microRNAs with an emphasis on app...
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Madelyn J. Blake, Clifford J. Steer Source Type: research
Viral Hepatitis and Acute-on-Chronic Liver Failure
Acute-on-chronic liver failure (ACLF) is a potentially reversible syndrome that develops in patients with cirrhosis or with underlying chronic liver disease (CLD) and is characterized by acute decompensation, organ failure, and high short-term mortality. Hepatitis A and hepatitis E are major causes of ACLF. Hepatitis B may also cause ACLF through a flare of hepatitis B, acute infection, or reactivation. Besides supportive care, nucleoside/nucleotide analog therapy should also be initiated in this setting. Nonhepatotropic viruses may rarely also cause ACLF with the severe acute respiratory syndrome coronavirus 2 virus recen...
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Talal Khushid Bhatti, Ashwani K. Singal, Paul Y. Kwo Source Type: research
Drug-Induced Acute-on-Chronic Liver Failure
Drug-induced liver injury (DILI) is a global problem related to prescription and over-the-counter medications as well as herbal and dietary supplements. It can lead to liver failure with the risk of death and need for liver transplantation. Acute-on-chronic liver failure (ACLF) may be precipitated by DILI and is associated with a high risk of mortality. This review addresses the challenges in defining the diagnostic criteria of drug-induced ACLF (DI-ACLF). The studies characterizing DI-ACLF and its outcomes are summarized, highlighting geographic differences in underlying liver disease and implicated agents, as are future ...
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Jiayi Ma, Marwan Ghabril, Naga Chalasani Source Type: research
Nonviral or Drug-Induced Etiologies of Acute-on-Chronic Liver Failure (Autoimmune, Vascular, and Malignant)
Vascular, autoimmune hepatitis, and malignant causes of acute-on-chronic liver failure are rare but important to consider and investigate in patients with underlying liver disease who present with acute deterioration and other more common etiologies have been excluded. Vascular processes including Budd –Chiari syndrome and portal vein thrombosis require imaging for diagnosis and anticoagulation is the mainstay of therapy. Patients may require advanced interventional therapy including transjugular intrahepatic portosystemic shunt or consideration of liver transplantation. Autoimmune hepatitis is a complex disease entity t...
Source: Clinics in Liver Disease - April 23, 2023 Category: Gastroenterology Authors: Suzanne A. Elshafey, Robert S. Brown Source Type: research
