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Evidence for and Against Liver Transplantation for Acute-on-Chronic Liver Failure

  • Liver (E Tapper, Section Editor)
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Current Treatment Options in Gastroenterology Aims and scope Submit manuscript

Abstract

Purpose of review

Liver transplantation for patients with acute-on-chronic liver failure (ACLF) is controversial. This article summarizes recent evidence for and against transplantation in ACLF.

Recent findings

Given the rising prevalence, high short-term mortality, and limited treatment options for ACLF, there is a clear survival benefit in transplanting this population. Multiple recent studies have demonstrated that survival outcomes at 1 year after transplant have improved to greater than 80%, due to growing clinical experience and an increasing body of literature to guide management. However, drawbacks to liver transplantation for these patients include difficulty in determining transplant futility and inferior non-survival outcomes, such as increased healthcare resource utilization and impaired long-term quality of life. Furthermore, lack of consensus on ACLF definition and heterogeneity of the patient population present challenges in incorporating ACLF into organ allocation policy.

Summary

For patients with ACLF, survival benefit and recent improvements in survival outcomes must be weighed against post-transplant futility and impaired short- and long-term non-survival outcomes.

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References and Recommended Reading

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Authors and Affiliations

  1. Department of Medicine, University of California, San Francisco, CA, USA

    Lisa Deng

  2. Division of Gastroenterology and Comprehensive Transplant Center, Cedars-Sinai Medical Center, 8900 Beverly Boulevard, Suite 250, Los Angeles, CA, 09,948, USA

    Vinay Sundaram

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Correspondence to Vinay Sundaram.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Lisa Deng declares that she has no conflict of interest.

Vinay Sundaram is a member of the speakers bureau for Gilead and Abbvie. He receives research funding from Durect, Grifols, and EF-CLIF. He has worked as a consultant for Saol therapeutics.

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Deng, L., Sundaram, V. Evidence for and Against Liver Transplantation for Acute-on-Chronic Liver Failure. Curr Treat Options Gastro 20, 194–204 (2022). https://doi.org/10.1007/s11938-022-00380-3

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