New Insights into Liver Failure
A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".
Deadline for manuscript submissions: 20 June 2024 | Viewed by 218
Special Issue Editor
Special Issue Information
Dear Colleagues,
The clinical course of cirrhosis has been typically characterized by compensated and decompensated states, which are based on the absence or, respectively, the presence of any gastrointestinal hypertensive bleeding, ascites, hepatic encephalopathy (HE) or jaundice.
Acute-on-chronic liver failure (ACLF) adds substantially to multistate modelling by identifying a subgroup of cirrhotic patients who may either have compensated or decompensated cirrhosis that can progress rapidly following acute decompensation (AD) to develop organ failure(s) (OFs) and high short-term mortality.
According to the EASL-CLIF Consortium definition, ACLF is a specific syndrome characterized by AD of cirrhosis, OF(s) and high short-term mortality. AD designates development of ascites, HE, gastrointestinal hemorrhage and/or bacterial infections; ACLF may develop in patients with or without a prior history of AD. OFs (liver, kidney, brain, coagulation, respiration, circulation) are defined by the CLIF-C OF score. High short-term mortality means a 28-day mortality rate ≥15%.
Liver transplantation (LT) represents the only definitive therapeutic option for patients with ACLF. Although ACLF patients have a high mortality rate on the waiting list, there are recent encouraging results showing that salvage LT is feasible and associated with a clear survival benefit in patients with ACLF, which is also the case for ACLF-3 patients.
The limits defining when a patient should be considered too sick for transplantation and the moment at which LT should be considered futile are currently not completely known.
Dr. Giovanni Perricone
Guest Editor
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Keywords
- cirrhosis
- acute decompensation
- organ failures
- acute-on-chronic liver failure
- liver transplantation
