The Decision for Liver Transplant in Acute on Chronic Liver Failure (ACLF) - First Week is the Crucial Period - Analysis of the Apasl ACLF Research Consortium (AARC) Prospective Data of 1021 Patients

Choudhury, Ashok; Sharma, Manish; Maiwal, Rakhi; Jain, Parvesh Kumar; Mahtab, M.A.; Yk, Chawla; Tan, Soek‐Siam; Ning, Qin; Devarbhavi, Harshad; Amarapurkar, D.; Kim, C.W.; Sadiq, Saleem; Butt, AS; Eapen, CE; Ghazinyan, Hasmik; Yu, Chunyao; Sood, Ajit; Lee, G.H.; Abbas, Zaigham; Shiha, Gamal; Lesmana, L.A.; Payawal, D.A.; Dokmeci, K.A.; Lau, George; Sarin, S.K.

doi:10.1016/s0168-8278(16)00046-5

Cited by 14 publications

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“…The chance of reversibility of ACLF is likely to decrease once the extrahepatic organ failure(s) sets in . Even the suitability for liver transplantation decreases in the presence of extrahepatic organ failure . It is therefore worthwhile to identify the short interim period between liver failure and the onset of extrahepatic organ failure and intervene during this potential therapeutic ‘golden window’.…”

Section: Introductionmentioning

confidence: 99%

“…12 Even the suitability for liver transplantation decreases in the presence of extrahepatic organ failure. 13 It is therefore worthwhile to identify the short interim period between liver failure and the onset of extrahepatic organ failure and intervene during this potential therapeutic 'golden window'. Scenarios where extrahepatic organ dysfunction precedes liver failure or sepsis precipitates liver failure, indeed, may have a different natural course and should form a different disease subgroup.…”

Section: Introductionmentioning

confidence: 99%

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Systemic inflammatory response syndrome in acute‐on‐chronic liver failure: Relevance of ‘golden window’: A prospective study

Choudhury

Kumar

Sharma

et al. 2017

J of Gastro and Hepatol

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Background and Aim Systemic inflammatory response syndrome (SIRS) is an early marker of sepsis and ongoing inflammation and has been reported in large proportion of acute‐on‐chronic liver failure (ACLF) patients. Whether sepsis is the cause or the result of liver failure is unclear and is vital to know. To address this, the study investigated the course and outcome of ACLF patients without SIRS/sepsis. Methods Consecutive ACLF patients were monitored for the development of SIRS/sepsis and associated complications and followed till 90 days, liver transplant or death. Results Of 561 patients, 201 (35.8%) had no SIRS and 360 (64.2%) had SIRS with or without infection. New onset SIRS and sepsis developed in 74.6% and 8% respectively in a median of 7 (range 4–15) days, at a rate of 11% per day. The cumulative incidence of new SIRS was 29%, 92.8%, and 100% by days 4, 7, and 15. Liver failure, that is, bilirubin > 12 mg/dL (odds ratio [OR] = 2.5 [95% confidence interval {CI} = 1.05–6.19], P = 0.04) at days 0 and 4, and renal failure at day 4 (OR = 6.74 [95%CI = 1.50–13.29], P = 0.01), independently predicted new onset SIRS. Absence of SIRS in the first week was associated with reduced incidence of organ failure (20% vs 39.4%, P = 0.003), as was the 28‐day (17.6% vs 36%, P = 0.02) and 90‐day (27.5% vs 51%,P = 0.002) mortality. The 90‐day mortality was 61.6% in the total cohort and that for those having no SIRS and SIRS at presentation were 42.8% and 65%, respectively (P < 0.001). Conclusion Liver failure predicts the development of SIRS. New onset SIRS in the first week is an important determinant of early sepsis, organ failure, and survival. Prompt interventions in this ‘golden window’ before development of sepsis may improve the outcome of ACLF.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Systemic inflammatory response syndrome in acute‐on‐chronic liver failure: Relevance of ‘golden window’: A prospective study

Choudhury

Kumar

Sharma

et al. 2017

J of Gastro and Hepatol

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“…Moreover, the CLIF‐C ACLF score computed between the third and seventh day from diagnosis predicts 28‐ and 90‐day mortality better than the CLIF‐C ACLF score calculated at the moment of ACLF diagnosis . A similar timeframe for orienting decision making toward emergent LT was suggested by another study performed by the APASL consortium . In the CANONIC experience, the majority of patients with d3‐7 ACLF 2 or 3 die during the first month of follow‐up (57% and 87% mortality rates, respectively; see Fig.…”

Section: The Ideal Timing Of Liver Transplantation In Acute‐on‐chronimentioning

confidence: 68%

“…(4) A similar timeframe for orienting decision making toward emergent LT was suggested by another study performed by the APASL consortium. (32) In the CANONIC experience, the majority of patients with d3-7 ACLF 2 or 3 die during the first month of follow-up (57% and 87% mortality rates, respectively; see Fig. 2A).…”

Section: Liver Graft Allocation Inmentioning

confidence: 97%

“…In the CANONIC study, the 90‐day mortality rate reached 100% only in patients with ACLF 3 and >4 OF or a CLIF‐C ACLF score > 64 at 3‐7 days after ACLF diagnosis . An Asian study showed that patients with a bilirubin level > 22 mg/dL, HE grade 3 or 4, INR > 2.5 with either creatinine level > 1 mg/dL or lactate > 1.5 mmol/L at baseline, and persistent derangement at day 4 or 7 had a mortality rate of 100% at 28 days . Thus, if LT is contraindicated or not available for patients fulfilling these criteria, intensive organ support should be considered to be futile.…”

Section: Futility Of Care Without Liver Transplantationmentioning

confidence: 99%

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New concepts in acute‐on‐chronic liver failure: Implications for liver transplantation

Putignano¹,

Gustot

2017

Liver Transpl

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Acute‐on‐chronic liver failure (ACLF) is a recently defined syndrome that occurs frequently in patients with cirrhosis and is associated with a poor short‐term prognosis. Currently, management of patients with ACLF is mainly supportive. Despite medical progress, this syndrome frequently leads to multiorgan failure, sepsis, and, ultimately, death. The results of attempts to use liver transplantation (LT) to manage this critical condition have been poorly reported but are promising. Currently, selection criteria of ACLF patients for LT, instructions for prioritization on the waiting list, and objective indicators for removal of ACLF patients from the waiting list in cases of clinical deterioration are poorly defined. Before potential changes can be implemented into decisional algorithms, their effects, either on the benefits to individual patients or on global transplant outcomes, should be carefully evaluated using objective longterm endpoints that take into account ethical considerations concerning LT. Liver Transplantation 23 234–243 2017 AASLD

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Referral to the Liver Transplant Center

Corradini

Ferri

2022

Textbook of Liver Transplantation

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The Decision for Liver Transplant in Acute on Chronic Liver Failure (ACLF) - First Week is the Crucial Period - Analysis of the Apasl ACLF Research Consortium (AARC) Prospective Data of 1021 Patients

Cited by 14 publications

References 0 publications

Systemic inflammatory response syndrome in acute‐on‐chronic liver failure: Relevance of ‘golden window’: A prospective study

Systemic inflammatory response syndrome in acute‐on‐chronic liver failure: Relevance of ‘golden window’: A prospective study

New concepts in acute‐on‐chronic liver failure: Implications for liver transplantation

Referral to the Liver Transplant Center

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