Article
Multidisciplinary Sciences
Peng Li, Xi Liang, Shan Xu, Ye Xiong, Jianrong Huang
Summary: This study aimed to evaluate the impact of artificial liver support system (ALSS) treatment before liver transplantation (LT), and assess the predictive values of current ACLF prognostic models for short-term prognosis after LT. The results showed that ALSS treatment combined with LT improved short-term survival rates in patients with HBV-related ACLF, and ALSS treatment pre-LT was identified as an independent protective factor affecting the 4-week survival rate after LT.
SCIENTIFIC REPORTS
(2021)
Review
Gastroenterology & Hepatology
Maria Pilar Ballester, Ahmed Elshabrawi, Rajiv Jalan
Summary: Acute-on-chronic liver failure (ACLF) is a life-threatening condition characterized by acute decompensation, organ failure, and high mortality risk. Extracorporeal liver support systems have been developed to improve outcomes, but their impact on survival remains unclear. DIALIVE, a novel liver support device, shows promise in reducing ACLF progression and is associated with faster recovery compared to standard treatment. Liver transplantation is a lifesaving option for severe ACLF patients, but careful patient selection is essential for optimal outcomes. This review discusses the current perspectives on extracorporeal liver support and liver transplantation for ACLF patients.
LIVER INTERNATIONAL
(2023)
Article
Multidisciplinary Sciences
Lingyao Du, Yuanji Ma, Shaoqun Zhou, Fang Chen, Yan Xu, Ming Wang, Xuezhong Lei, Ping Feng, Hong Tang, Lang Bai
Summary: The PALS score can reliably predict the 3-month prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure and suggest which subgroups may benefit from PE-centered ALSS therapy.
SCIENTIFIC REPORTS
(2021)
Review
Gastroenterology & Hepatology
Florent Artru, David Goldberg, Patrick S. Kamath
Summary: The authors debate whether patients with acute-on-chronic liver failure grade 3 (ACLF-3) should have higher liver transplant priority. They present a clinical case of a 62-year-old male with decompensated alcohol-associated cirrhosis and multiple comorbidities. The patient is at an exceedingly high risk of death without liver transplantation based on the severity of his liver disease and multiorgan failure.
JOURNAL OF HEPATOLOGY
(2023)
Review
Gastroenterology & Hepatology
Fin S. Larsen, Faouzi Saliba
Summary: Acute liver failure (ALF) leads to numerous complications, resulting in multi-organ failure. This review focuses on the pathophysiological processes and management strategies using artificial liver support and liver transplantation (LT). The deterioration in ALF is caused by hyperammonemia and release of DAMPs, leading to hepatic encephalopathy, cerebral edema, and inflammatory activation. Continuous renal replacement therapy (CRRT) and plasma exchange are effective in removing ammonia and DAMPs. LT criteria for non-paracetamol cases are robust, but criteria for paracetamol-intoxicated patients are more unreliable. Post-LT survival rates have significantly improved, reaching 90% for patients needing LT for survival.
LIVER INTERNATIONAL
(2023)
Review
Gastroenterology & Hepatology
William Bernal, Constantine Karvellas, Faouzi Saliba, Fuat H. Saner, Philippe Meersseman
Summary: Acute-on-chronic liver failure syndrome involves liver function deterioration, extrahepatic organ failure, and high mortality rate, requiring rapid and coherent management in the intensive care unit to improve patient outcomes.
JOURNAL OF HEPATOLOGY
(2021)
Article
Gastroenterology & Hepatology
Francois Durand, Olivier Roux, Emmanuel Weiss, Claire Francoz
Summary: Acute-on-chronic liver failure (ACLF) is a disease characterized by rapid organ failure in patients with cirrhosis, with high mortality rates. The severity of ACLF can be classified into three grades, with grade 3 showing over 70% mortality within 28 days. While infections and bleeding are common causes, around 60% of ACLF cases have unidentified precipitating factors. Identifying high-risk cirrhosis patients and managing them carefully are crucial in preventing ACLF.
LIVER INTERNATIONAL
(2021)
Review
Medicine, General & Internal
Carmine Gambino, Salvatore Piano, Paolo Angeli
Summary: ACLF is a syndrome that develops in patients with acutely decompensated chronic liver disease, characterized by high mortality, organ failures, and systemic inflammation. Different scientific societies have proposed diagnostic criteria and clinical characteristics for ACLF, along with established and experimental treatments. Further research is needed to better understand the pathophysiology of the syndrome and explore new therapies.
JOURNAL OF CLINICAL MEDICINE
(2021)
Article
Gastroenterology & Hepatology
Xiao-hao Wang, Bin-bin Peng, Lu Zhang, Jing Zhao, Li Zhang, Hong Ren, Peng Hu, Hu Li, Shan Zhong
Summary: This study compared the effects of mixed using different modes of ALS (MALS) and single using one mode of ALS (SALS) on the 28- and 90-day survival rates of ACLF patients. The results showed that the MALS group had significantly lower 28- and 90-day mortalities compared to the SALS group, especially in advanced stages of the disease.
HEPATOLOGY INTERNATIONAL
(2023)
Article
Pediatrics
Chun-Feng Yang, Jing-Wei Liu, Lin-Mei Jin, Yu-Mei Li
Summary: This study aimed to evaluate the efficacy of the artificial liver support system (ALSS) in pediatric acute liver failure (PALF) patients and examine the risk factors associated with its effect. The results showed that ALSS can effectively reduce certain blood indicators and may reduce mortality. The reduction in TBIL levels after ALSS is dependent on the etiology. Additionally, a longer duration of ALSS was associated with a reduction in blood ammonia.
FRONTIERS IN PEDIATRICS
(2022)
Article
Microbiology
Zhiying Song, Qiong Xie, Yao Zhou, Shufen Song, Zhen Gao, Yu Lan, Zhiguo Wu, Hongxin Cai, Dongshan Yu, Cuiyun Liu, Junrong Liang, Baogang Xie, Shuilin Sun
Summary: This study investigated the effect of artificial liver support systems (ALSS) on the abundance and diversity of gut microbiota in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). The results showed that ALSS treatment can alter the composition of gut microbiota, reduce potentially harmful bacteria, increase potentially beneficial bacteria, and improve gut microecological imbalance. Blautia and Coprococcus may have great potential as biomarkers.
Article
Radiology, Nuclear Medicine & Medical Imaging
Antoine Wackenthaler, Sebastien Moliere, Thierry Artzner, Baptiste Michard, Maleka Schenck, Pietro Addeo, Camille Besch, Philippe Bachellier, Francis Schneider, Francis Veillon, Francois Faitot
Summary: Pre-operative imaging, specifically contrast-enhanced abdominal CT, was found to be significantly valuable in predicting post-transplantation survival in critically ill cirrhotic patients with severe ACLF. Three independent CT-derived prognostic factors - splenomegaly, liver atrophy, and vena cava diameter ratio - were identified and used to build a simple prognostic score, which was found to be an independent predictive factor in association with the Transplantation for ACLF3 Model (TAM) score, for predicting 1-year survival after liver transplantation.
EUROPEAN RADIOLOGY
(2022)
Article
Gastroenterology & Hepatology
Rajiv Jalan, Thierry Gustot, Javier Fernandez, William Bernal
Summary: Acute-on-chronic liver failure (ACLF) is a complex syndrome with high short-term mortality rates in patients with cirrhosis. Current liver transplantation policies do not adequately meet the needs of ACLF patients, leading to a call for prioritizing liver transplantation for these patients.
JOURNAL OF HEPATOLOGY
(2021)
Review
Medicine, General & Internal
Arshi Khanam, Shyam Kottilil
Summary: ACLF is a complex disease that can occur in patients with or without liver cirrhosis, with pathophysiological mechanisms involving systemic inflammation and acute hepatic insult. Currently, no specific and definitive treatment is available apart from liver transplantation. Regenerative medicine using MSCs shows potential as an alternative treatment for ACLF.
FRONTIERS IN MEDICINE
(2021)
Review
Gastroenterology & Hepatology
Constantine J. J. Karvellas, Thierry Gustot, Javier Fernandez
Summary: Acute on chronic liver failure (ACLF) is the development of organ failure(s) in cirrhosis patients and has a high short-term mortality rate. Medical management of ACLF needs to consider the relationship between the underlying chronic liver disease/cirrhosis, precipitating insult, and involved organ systems. Intensive care management of ACLF focuses on promptly recognizing and treating triggering events and providing aggressive support for failing organs to ensure successful liver transplantation or recovery. The complexity of managing ACLF patients arises from their propensity to develop new organ failures and complications like infections or bleeding. A multidisciplinary team with expertise in critical care and transplant medicine is best suited for the management of critically ill ACLF patients. This review aims to identify common complications of ACLF and describe the appropriate management for critically ill patients awaiting liver transplantation, including organ support, prognostic assessment, and determining the likelihood of recovery.
LIVER INTERNATIONAL
(2023)