Liver transplantation for ACLF

Czech version

Authors: K. Chmelová
Authors‘ workplace: Klinika hepatogastroenterologie, Transplantcentrum, Institut klinické a experimentální medicíny, Praha
Published in: Gastroent Hepatol 2024; 78(2): 101-107
Category: Hepatology
doi: https://doi.org/10.48095/ccgh2024101

Overview

Acute-on-chronic liver failure (ACLF) occurs in about one third of patients hospitalized for decmopensation of liver cirrhosis. It is defined as a failure of at least one organ, mostly the kidneys and/or liver, and very high short-term mortality. The most common trigger, precipitating event, is an infection or alcohol abuse. ACLF is caused by an excessive inflammatory reaction to the presence od microbial or sterile molecular structures in the blood circulation, and a disturbed immune response. ACLF is a very dynamic process and the condition must be reevaluated continuously according to the available scoring systems, early contact the transplant center and consider the possibility of this only curative treatment. We should be aware of renal function, nutrition, antimicrobial treatment and in patients with alcoholic hepatitis, it is necessary to consider the administration of corticosteroids. Liver transplantation for ACLF has somewhat worse one-year survival compared to other transplant groups, but long-term survival is comparable.

Keywords:

ACLF – precipitating event – alcohol hepatitis – infection – liver transplantation

Sources

1. Arroyo V, Moreau R, Kamath PS et al. Acute-on-chronic liver failure in cirrhosis. Nat Rev Dis Primers 2016; 2: 16041. doi: 10.1038/nrdp.2016.41.

2. European Association for the Study of the Liver. EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis. J Hepatol 2018; 69 (2): 406–460. doi: 10.1016/j.jhep.2018.03.024.

3. Jalan R, Williams R. Acute-on-chronic liver failure: pathophysiological basis of therapeutic options. Blood Purif 2002; 20 (3): 252–261. doi: 10.1159/000047017.

4. Jalan R, Yurdaydin C, Bajaj JS et al. Toward an improved definition of acute-on-chronic liver failure. Gastroenterology 2014; 147 (1): 4–10. doi: 10.1053/j.gastro.2014.05.005.

5. Moreau R, Jalan R, Gines P et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology 2013; 144 (7): 1426–1437. doi: 10.1053/j.gastro.2013.02.042.

6. O’Leary JG, Reddy KR, Garcia-Tsao G et al. NACSELD acute-on-chronic liver failure (NACSELD-ACLF) score predicts 30-day survival in hospitalized patients with cirrhosis. Hepatology 2018; 67 (6): 2367–2374. doi: 10.1002/hep.29773.

7. Sarin SK, Choudhury A, Sharma MK et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hepatol Int 2019; 13 (4): 353–390. doi: 10.1007/s12072-019-09946-3.

8. Moreau R, Jalan R, Arroyo V. Acute-on-chronic liver failure: recent concepts. J Clin Exp Hepatol 2015; 5 (1): 81–85. doi: 10.1016/j.jceh. 2014.09.003.

9. Hernaez R, Sola E, Moreau R et al. Acute-on-chronic liver failure: an update. Gut 2017; 66 (3): 541–553. doi: 10.1136/gutjnl-2016-312670.

10. Zaccherini G, Weiss E, Moreau R. Acute-on-chronic liver failure: definitions, pathophysiology and principles of treatment. JHEP Rep 2021; 3 (1): 100176. doi: 10.1016/j.jhepr.2020.100176.

11. Jalan R, Saliba F, Pavesi M et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol 2014; 61 (5): 1038–1047. doi: 10.1016/j.jhep.2014.06.012.

12. Moreau R. The pathogenesis of ACLF: the inflammatory response and immune function. Semin Liver Dis 2016; 36 (2): 133–140. doi: 10.1055/s-0036-1583199.

13. European Association for the Study of the Liver. EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis. J Hepatol 2010; 53 (3): 397–417. doi: 10.1016/j.jhep.2010.05.004.

14. Kim JJ, Tsukamoto MM, Mathur AK et al. Delayed paracentesis is associated with increased in-hospital mortality in patients with spontaneous bacterial peritonitis. Am J Gastroenterol 2014; 109 (9): 1436–1442. doi: 10.1038/ajg.2014. 212.

15. Jimenez C, Ventura-Cots M, Sala M et al. Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis: a pilot study (RIFA-AH). Liver Int 2022; 42 (5): 1109–1120. doi: 10.1111/liv.15207.

16. Trebicka J, Bork P, Krag A et al. Utilizing the gut microbiome in decompensated cirrhosis and acute-on-chronic liver failure. Nat Rev Gastroenterol Hepatol 2021; 18 (3): 167–180. doi: 10.1038/s41575-020-00376-3.

17. Maddrey WC, Boitnott JK, Bedine MS et al. Corticosteroid therapy of alcoholic hepatitis. Gastroenterology 1978; 75 (2): 193–199.

18. Louvet A, Naveau S, Abdelnour M et al. The Lille model: a new tool for therapeutic strategy in patients with severe alcoholic hepatitis treated with steroids. Hepatology 2007; 45 (6): 1348–1354. doi: 10.1002/hep.21607.

19. Davenport A, Faisal Sheikh M, Lamb E et al. Acute kidney injury in acute-on-chronic liver failure: where does hepatorenal syndrome fit? Kidney Int 2017; 92 (5): 1058–1070. doi: 10.1016/j.kint.2017.04.048.

20. Kulkarni AV, Ravikumar ST, Tevethia H et al. Safety and efficacy of terlipressin in acute-on-chronic liver failure with hepatorenal syndrome-acute kidney injury (HRS-AKI): a prospective cohort study. Sci Rep 2022; 12 (1): 5503. doi: 10.1038/s41598-022-09505-1.

21. Zhang Z, Maddukuri G, Jaipaul N et al. Role of renal replacement therapy in patients with type 1 hepatorenal syndrome receiving combination treatment of vasoconstrictor plus albumin. J Crit Care 2015; 30 (5): 969–974. doi: 10.1016/j.jcrc.2015.05.006.

22. Plauth M, Bernal W, Dasarathy S et al. ESPEN guideline on clinical nutrition in liver disease. Clin Nutr 2019; 38 (2): 485–521. doi: 10.1016/ j.clnu.2018.12.022.

23. Stadlbauer V, Krisper P, Aigner R et al. Effect of extracorporeal liver support by MARS and Prometheus on serum cytokines in acute-on-chronic liver failure. Crit Care 2006; 10 (6): R169. doi: 10.1186/cc5119.

24. Rocen M, Kieslichova E, Merta D et al. The effect of Prometheus device on laboratory markers of inflammation and tissue regeneration in acute liver failure management. Transplant Proc 2010; 42 (9): 3606–3611. doi: 10.1016/ j.transproceed.2010.07.103.

25. Krisper P, Haditsch B, Stauber R et al. In vivo quantification of liver dialysis: comparison of albumin dialysis and fractionated plasma separation. J Hepatol 2005; 43 (3): 451–457. doi: 10.1016/j.jhep.2005.02.038.

26. Larsen FS, Schmidt LE, Bernsmeier C et al. High-volume plasma exchange in patients with acute liver failure: an open randomised controlled trial. J Hepatol 2016; 64 (1): 69–78. doi: 10.1016/j.jhep.2015.08.018.

27. Tan EX, Wang MX, Pang J et al. Plasma exchange in patients with acute and acute-on-chronic liver failure: a systematic review. World J Gastroenterol 2020; 26 (2): 219–245. doi: 10.3748/wjg.v26.i2.219.

28. Belli LS, Duvoux C, Artzner T et al. Liver transplantation for patients with acute-on-chronic liver failure (ACLF) in Europe: results of the ELITA/EF-CLIF collaborative study (ECLIS). J Hepatol 2021; 75 (3): 610–622. doi: 10.1016/ j.jhep.2021.03.030.

29. Agbim U, Sharma A, Maliakkal B et al. Outcomes of liver transplant recipients with acute-on-chronic liver failure based on EASL-CLIF consortium definition: a single-center study. Transplant Direct 2020; 6 (4): e544. doi: 10.1097/TXD.0000000000000984.

ORCID autorky

K. Chmelová 0000-0003-1414-6580.

Doručeno/Submitted: 18. 3. 2024

Přijato/Accepted: 25. 3. 2024

MUDr. Klára Chmelová

Klinika hepatogastroenterologie

Institut klinické a experimentální medicíny

Vídeňská 1958/9

140 21 Praha 4

chmk@ikem.cz