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ACLF and Liver Transplantation

  • Liver (J Bajaj, Section Editor)
  • Published:
Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

The prevalence, mechanisms, and outcomes of acute-on-chronic liver failure (ACLF) pretransplant that affect post-transplant results are herein summarized.

Recent findings

ACLF, 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.

Summary

Highly 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.

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Authors and Affiliations

  1. Dallas VA Medical Center, Dallas, TX, USA

    Jacqueline G. O’Leary MD, MPH

  2. UTSW, Dallas, TX, USA

    Jacqueline G. O’Leary MD, MPH

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  1. Jacqueline G. O’Leary MD, MPH
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Correspondence to Jacqueline G. O’Leary MD, MPH.

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Jacqueline G. O’Leary is in the speaker’s bureau for Gilead and AbbVie and serves as a consultant for Astellas.

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This article does contain studies with human performed by the author but not animal studies performed by the author.

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This article is part of the Topical Collection on Liver

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O’Leary, J.G. ACLF and Liver Transplantation. Curr Treat Options Gastro 19, 473–482 (2021). https://doi.org/10.1007/s11938-021-00354-x

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