P476 Short-Term (28-Day) Clinical Course and Transplant-Free Mortality in Acute on Chronic Liver Failure (Aclf); Evidence for Reversibility of Aclf (A Study From the Canonic Database)

Type of organ failure and acute insult have important bearings in outcomes of liver transplantation: A pragmatic discourse

“…[2][3][4] The higher propensity of short-term mortality without transplantation in cirrhotics with multi-organ failures especially with ≥3 organ failures irrespective of the definition used is well established. 5 The rapidly downhill course provides a very small window to transplant, and this study reinforces the fact that the crux lies in the appropriate selection of patients to balance imminent mortality without transplant against peri-transplant complications and overall graft and patient survival after transplantation. 3 However we still have reservations about transplanting patients with multi-organ failures and would like to raise certain pertinent issues concerning the study by Thuluvath et al 1 Firstly, the authors have pointed out that the type of organ failure had only minimal impact on survival although overall respiratory failure was associated with lower 1-year survival.…”

Liver Transplantation for Acute on Chronic Liver Failure

“…The grade of ACLF at day 3-7 was better to predict prognosis than grade of ACLF at admission. 7 The final grade of ACLF remained same as ACLF grade at day 3-7 in 81% of patients. As course of ACLF patients may change rapidly, it is important to identify need of LT before patients develop multi-OF and do not remain candidates for transplant.…”

“…As course of ACLF patients may change rapidly, it is important to identify need of LT before patients develop multi-OF and do not remain candidates for transplant. 7 The authors found CLIF-C ACLF and liver failure as independent prognostic markers of early severe copurse. 7 ACLF resolved or improved in 49.5% patients, it remained steady or fluctuating in 30.4% and worsened in 20.1% (CANONIC database).…”

“…7 The authors found CLIF-C ACLF and liver failure as independent prognostic markers of early severe copurse. 7 ACLF resolved or improved in 49.5% patients, it remained steady or fluctuating in 30.4% and worsened in 20.1% (CANONIC database). The resolution rates were 54.5%, 34.6% and 16% for ACLF grade 1, 2 and 3 respectively.…”

“…ACLF patients have a significant risk of development of OFs and mortality in absence of improvement and liver transplantation (LT) should be considered in such patients before development of multi -OF. [7][8][9] Thus, these patients have a small window of opportunity (LT) before development of OFs and it is important to identify prognosis of ACLF before it is too late. 10…”