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Hepatology International

, Volume 9, Issue 4, pp 508–513 | Cite as

Liver transplantation in acute-on-chronic liver failure: lessons learnt from acute liver failure setting

  • Mettu Srinivas Reddy
  • Rajesh Rajalingam
  • Mohamed RelaEmail author
Review Article

Abstract

Acute-on-chronic liver failure is a clinical entity with high risk of mortality. These patients can have severe liver dysfunction complicated with multiple organ failure. Liver transplantation is the definitive treatment for these patients. Literature regarding management of acute liver failure with special emphasis on liver transplantation was reviewed. Lessons learnt from the management of patients with acute liver failure which could be extrapolated to the management of patients with acute-on-chronic liver failure are discussed. Significant improvement in outcomes of acute liver failure has been reported across the world. Several aspects in transplantation for acute liver failure were found to be relevant to the management of acute-on-chronic liver failure. These include defining criteria to identify patients needing early liver transplantation, prioritizing patients with acute liver failure on the waiting list, defining when to abandon transplantation in acute liver failure, emphasis on graft quality and the need for a multi-disciplinary approach to manage multiple organ dysfunction. Useful lessons can be learnt from the progress made in the management of acute liver failure and these can be extrapolated to the management of patients with acute-on-chronic liver failure.

Keywords

Acute-on-chronic liver failure Acute liver failure Liver transplantation Listing criteria Multi organ dysfunction 

Notes

Compliance with ethical requirements and Conflict of interest

Mettu Srinivas Reddy, Rajesh Rajalingam and Mohamed Rela declare that they have complied with all ethical requirements during the preparation of this manuscript. Mettu Srinivas Reddy, Rajesh Rajalingam and Mohamed Rela declare that they have no conflict of interest.

References

  1. 1.
    Sarin SK, Kumar A, Almeida JA, Chawla YK, Fan ST, Garg H, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL). Hepatol Int 2009;3(1):269–282PubMedCentralCrossRefPubMedGoogle Scholar
  2. 2.
    Bajaj JS. Defining acute-on-chronic liver failure: will East and West ever meet? Gastroenterology 2013;144(7):1337–1339CrossRefPubMedGoogle Scholar
  3. 3.
    Kim TY, Kim DJ. Acute-on-chronic liver failure. Clin Mol Hepatol 2013;19(4):349–359PubMedCentralCrossRefPubMedGoogle Scholar
  4. 4.
    Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, Garcia-Tsao G, et al. Acute-on-chronic liver failure. J Hepatol 2012;57(6):1336–1348CrossRefPubMedGoogle Scholar
  5. 5.
    Graziadei IW. The clinical challenges of acute on chronic liver failure. Liver Int 2011;31(Suppl 3):24–26CrossRefPubMedGoogle Scholar
  6. 6.
    Bernal W, Wendon J. Acute liver failure. N Engl J Med 2013;369(26):2525–2534CrossRefPubMedGoogle Scholar
  7. 7.
    Bernal W, Hyyrylainen A, Gera A, Audimoolam VK, McPhail MJ, Auzinger G, et al. Lessons from look-back in acute liver failure? A single centre experience of 3300 patients. J Hepatol 2013;59(1):74–80CrossRefPubMedGoogle Scholar
  8. 8.
    Bernal W, Cross TJ, Auzinger G, Sizer E, Heneghan MA, Bowles M, et al. Outcome after wait-listing for emergency liver transplantation in acute liver failure: a single centre experience. J Hepatol 2009;50(2):306–313CrossRefPubMedGoogle Scholar
  9. 9.
    O’Grady JG, Alexander GJ, Hayllar KM, Williams R. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989;97(2):439–445PubMedGoogle Scholar
  10. 10.
    Cholongitas E, Theocharidou E, Vasianopoulou P, Betrosian A, Shaw S, Patch D, et al. Comparison of the sequential organ failure assessment score with the King’s College Hospital criteria and the model for end-stage liver disease score for the prognosis of acetaminophen-induced acute liver failure. Liver Transplant 2012;18(4):405–412CrossRefGoogle Scholar
  11. 11.
    Umgelter A, Lange K, Kornberg A, Büchler P, Friess H, Schmid RM. Orthotopic liver transplantation in critically ill cirrhotic patients with multi-organ failure: a single-center experience. Transplant Proc 2011;43(10):3762–3768CrossRefPubMedGoogle Scholar
  12. 12.
    Garg H, Kumar A, Garg V, Sharma P, Sharma BC, Sarin SK. Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure. Dig Liver Dis 2012;44(2):166–171CrossRefPubMedGoogle Scholar
  13. 13.
    Chan AC, Fan ST, Lo CM, Liu CL, Chan SC, Ng KK, et al. Liver transplantation for acute-on-chronic liver failure. Hepatol Int 2009;3(4):571–581PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Bahirwani R, Shaked O, Bewtra M, Forde K, Reddy KR. Acute-on-chronic liver failure before liver transplantation: impact on posttransplant outcomes. Transplantation 2011;92(8):952–957CrossRefPubMedGoogle Scholar
  15. 15.
    Ling Q, Xu X, Wei Q, Liu X, Guo H, Zhuang L, et al. Downgrading MELD improves the outcomes after liver transplantation in patients with acute-on-chronic hepatitis B liver failure. PLoS ONE 2012;7(1):e30322PubMedCentralCrossRefPubMedGoogle Scholar
  16. 16.
    Wlodzimirow KA, Eslami S, Abu-Hanna A, Nieuwoudt M, Chamuleau RA. A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality. Liver Int 2013;33(1):40–52CrossRefPubMedGoogle Scholar
  17. 17.
    Zheng YB, Huang ZL, Wu ZB, Zhang M, Gu YR, Su YJ, et al. Dynamic changes of clinical features that predict the prognosis of acute-on-chronic hepatitis B liver failure: a retrospective cohort study. Int J Med Sci 2013;10(12):1658–1664PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Pan HC, Jenq CC, Tsai MH, Fan PC, Chang CH, Chang MY, et al. Scoring systems for 6-month mortality in critically ill cirrhotic patients: a prospective analysis of chronic liver failure—sequential organ failure assessment score (CLIF-SOFA). Aliment Pharmacol Therap 2014;40(9):1056–1065Google Scholar
  19. 19.
    McPhail MJ, Shawcross DL, Abeles RD, Chang A, Patel V, Lee GH, et al. Increased survival for patients with cirrhosis and organ failure in liver intensive care and validation of the chronic liver failure-sequential organ failure scoring system. Clin Gastroenterol Hepatol 2014Google Scholar
  20. 20.
    O’Grady J. Liver transplantation for acute liver failure. Best Pract Res Clin Gastroenterol 2012;26(1):27–33CrossRefPubMedGoogle Scholar
  21. 21.
    Jc O, Ps K. Acute-on-chronic liver failure: concept, natural history, and prognosis. Curr Opin Crit Care 2011;17(2):165–169CrossRefGoogle Scholar
  22. 22.
    Sharma P, Schaubel DE, Gong Q, Guidinger M, Merion RM. End-stage liver disease candidates at the highest model for end-stage liver disease scores have higher wait-list mortality than status-1A candidates. Hepatology (Baltimore, MD) 2012;55(1):192–198CrossRefGoogle Scholar
  23. 23.
    Washburn K, Pomfret E, Roberts J. Liver allocation and distribution: possible next steps. Liver Transplant 2011;17(9):1005–1012Google Scholar
  24. 24.
    Miyake Y, Yasunaka T, Ikeda F, Takaki A, Nouso K, Yamamoto K. SIRS score reflects clinical features of non-acetaminophen-related acute liver failure with hepatic coma. Intern Med 2012;51(8):823–828CrossRefPubMedGoogle Scholar
  25. 25.
    Poddar B, Saigal S, Kumar A, Singh RK, Azim A, Gurjar M, et al. Factors associated with outcome in acute liver failure in an intensive care unit. Indian J Gastroenterol 2013;32(3):172–178CrossRefPubMedGoogle Scholar
  26. 26.
    Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, Garcia-Tsao G, et al. Acute-on-chronic liver failure. J Hepatol 2012;57(6):1336–1348CrossRefPubMedGoogle Scholar
  27. 27.
    Cholongitas E, Marelli L, Shusang V, Senzolo M, Rolles K, Patch D, et al. A systematic review of the performance of the model for end-stage liver disease (MELD) in the setting of liver transplantation. Liver Transplant 2006;12(7):1049–1061CrossRefGoogle Scholar
  28. 28.
    Cholongitas EB, Betrossian A, Leandro G, Shaw S, Patch D, Burroughs AK. King’s criteria, APACHE II, and SOFA scores in acute liver failure. Hepatology (Baltimore, MD) 2006;43(4):881 (author reply 2)CrossRefGoogle Scholar
  29. 29.
    Rolando N, Philpott-Howard J, Williams R. Bacterial and fungal infection in acute liver failure. Semin Liver Dis 1996;16(4):389–402CrossRefPubMedGoogle Scholar
  30. 30.
    Karvellas CJ, Pink F, McPhail M, Austin M, Auzinger G, Bernal W, et al. Bacteremia, acute physiology and chronic health evaluation II and modified end stage liver disease are independent predictors of mortality in critically ill nontransplanted patients with acute on chronic liver failure. Crit Care Med 2010;38(1):121–126CrossRefPubMedGoogle Scholar
  31. 31.
    Lin KH, Liu JW, Chen C-L, Wang S-H, Lin C-C, Liu Y-W, et al. Impacts of pretransplant infections on clinical outcomes of patients with acute-on-chronic liver failure who received living-donor liver transplantation. PLoS ONE 2013;8(9)Google Scholar
  32. 32.
    Duan BW, Lu SC, Wang ML, Liu JN, Chi P, Lai W, et al. Liver transplantation in acute-on-chronic liver failure patients with high model for end-stage liver disease (MELD) scores: a single center experience of 100 consecutive cases. J Surg Res 2013;183(2):936–943CrossRefPubMedGoogle Scholar
  33. 33.
    Germani G, Theocharidou E, Adam R, Karam V, Wendon J, O’Grady J, et al. Liver transplantation for acute liver failure in Europe: outcomes over 20 years from the ELTR database. J Hepatol 2012;57(2):288–296CrossRefPubMedGoogle Scholar
  34. 34.
    Lo CM. Living donor liver transplantation for acute liver failure: no other choice. Liver Transplant 2012;18(9):1005–1006CrossRefGoogle Scholar
  35. 35.
    Ates M, Hatipoglu S, Dirican A, Isik B, Ince V, Yilmaz M, et al. Right-lobe living-donor liver transplantation in adult patients with acute liver failure. Transpl Proc 2013;45(5):1948–1952CrossRefGoogle Scholar
  36. 36.
    Urrunaga NH, Rachakonda VP, Magder LS, Mindikoglu AL. Outcomes of living versus deceased donor liver transplantation for acute liver failure in the United States. Transplant Proc 2014;46(1):219–224PubMedCentralCrossRefPubMedGoogle Scholar
  37. 37.
    Yamashiki N, Sugawara Y, Tamura S, Nakayama N, Oketani M, Umeshita K, et al. Outcomes after living donor liver transplantation for acute liver failure in Japan: results of a nationwide survey. Liver Transplant 2012;18(9):1069–1077CrossRefGoogle Scholar
  38. 38.
    Jiang L, Yan L, Tan Y, Li B, Wen T, Yang J, et al. Adult-to-adult right-lobe living donor liver transplantation in recipients with hepatitis B virus-related benign liver disease and high model end-stage liver disease scores. Surg Today 2013;43(9):1039–1048CrossRefPubMedGoogle Scholar
  39. 39.
    Lin KH, Liu JW, Chen CL, Wang SH, Lin CC, Liu YW, et al. Impacts of pretransplant infections on clinical outcomes of patients with acute-on-chronic liver failure who received living-donor liver transplantation. PLoS ONE 2013;8(9):e72893PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Asian Pacific Association for the Study of the Liver 2015

Authors and Affiliations

  • Mettu Srinivas Reddy
    • 1
  • Rajesh Rajalingam
    • 1
  • Mohamed Rela
    • 1
    Email author
  1. 1.National Foundation for Liver Research, Institute of Liver Disease and TransplantationGlobal Health CityChennaiIndia

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