Acute-on-Chronic Liver Failure: Diagnosis to Liver Transplantation

Abstract

Introduction: Patients with acute-on-chronic liver failure (ACLF) have different characteristics from those presented by non-ACLF patients with liver diseases. The degree of ACLF impacts the outcome with or without transplantation, with divergences in the literature, especially regarding post-transplant prognosis. Objectives: To review the different aspects of patients with ACLF, including the concepts of the syndrome adopted by various institutions, the treatment of complications, and to describe the knowledge about the outcomes with or without transplantation of patients with the syndrome reported in the literature. Methods: Twenty-two articles were included in the PubMed, MEDLINE and theScientific Electronic Library Online(SciELO) databases with the descriptors “ACLF definitions” and “Liver transplantation ACLF.” The concepts and data from the selected texts were compared and used as a basis for writing this article. Results: There are some differences in the definition of the syndrome, varying especially between Western and Eastern countries. ACLF patients awaiting liver transplantation have characteristics distinct from those presented by non-ACLF patients. The degree of ACLF also impacts the outcome with or without transplantation, with divergences in the literature especially regarding the post-transplant prognosis of ACLF-3  patients, with an increasing trend in the indication of transplantation even for these patients. Conclusions: Outcomes vary  among ACLF patients according to the degree of the disease. Liver transplantation has been more frequently indicated in ACLF-3, with waiting time impacting outcomes. Further studies are needed to define which subgroups of patients benefit most from liver transplantation.