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• W4210557246 abstract "Acute‐on‐chronic liver failure (ACLF) is a syndrome of systemic inflammation and multiple organ system failures that is associated with a significantly high 28‐day mortality ranging from 15% to 89%.1 Although several definitions for ACLF exist, it is generally agreed upon that this condition yields greater non‐transplant mortality than mere decompensated cirrhosis. Furthermore, with the rising burden of liver disease throughout the world, secondary epidemic rises in alcoholic liver disease, and metabolic dysfunction associated liver disease, ACLF is subsequently increasing in prevalence both in the United States2 and globally.3 Unfortunately, no medical treatment currently exists for patients with ACLF, thereby making liver transplantation (LT) the only therapeutic option, particularly in those with two or more organ failures. Over the past several years, however, multiple studies have been published to advance our knowledge in the field of LT in the setting of ACLF. Previously, investigations exploring the role of LT in the setting of ACLF were limited to a small sample size, particularly among patients with three or more organ failures, often known as acute‐on‐chronic liver failure grade 3 (ACLF‐3). More recently, however, several analyses of the United Network for Organ Sharing (UNOS) database, which allows for the study of thousands of patients, have yielded important findings regarding the feasibility of transplantation in the ACLF population4‐6 and waiting list mortality associated with transplant candidates with ACLF under current organ allocation policy.4,7 Additional studies have been subsequently published using primary source and public registry data, which have both corroborated and built upon these initial findings.8‐10 However, significant knowledge gaps still remain regarding LT for patients with ACLF, including defining in which patients transplantation would be futile, understanding how to manage patients with severe ACLF in the peri‐transplant and post‐transplant periods to maximize patient survival, and whether candidates with ACLF should be afforded greater priority on the transplant waiting list. In this issue of Clinical Liver Diseases, we will discuss several of these knowledge gaps as based on published data and expert opinion. We will begin with an introduction to ACLF and a discussion regarding the differences between the several existing definitions of ACLF. We will then examine medical and surgical considerations regarding the management of the transplant recipient with ACLF from the perspective of critical care, transplant surgery, and post‐transplant immunosuppression, along with a review of risk factors which may indicate that LT may be futile. We will conclude the issue with a debate regarding the appropriateness of allocating additional priority for transplantation to patients who have developed ACLF. Author contributions Drafting of manuscript: VS Guarantor of the article: Vinay Sundaram All authors approved the final version of the article, including the authorship list." @default.
• W4210557246 created "2022-02-08" @default.
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• W4210557246 date "2022-05-01" @default.
• W4210557246 modified "2023-09-27" @default.
• W4210557246 title "Introduction: The Role of Liver Transplantation in Acute-on-Chronic Liver Failure" @default.
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• W4210557246 doi "https://doi.org/10.1002/cld.1181" @default.
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