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Williams. Hepatoma Res 2017;3:90-4 Hepatoma Research
DOI: 10.20517/2394-5079.2017.13
www.hrjournal.net
Editorial Open Access

Liver transplantation in acute-on-chronic

liver failure

Roger Williams
1,2
1 Institute of Hepatology London, Foundation for Liver Research, London SE5 9NT, UK.
2 Faculty of Life Sciences & Medicine, King’s College London, London SE5 9NT, UK.

Correspondence to: Prof. Roger Williams, Institute of Hepatology London, Foundation for Liver Research, 111 Coldharbour Lane, London SE5 9NT,
UK. E-mail: r.williams@researchinliver.org.uk

How to cite this article: Williams R. Liver transplantation in acute-on-chronic liver failure. Hepatoma Res 2017;3:90-4.
Article history: Received: 31-03-2017 Accepted: 07-04-2017 Published: 17-05-2017

Over the past five years, we have gained much new or bacterial infection develops in more than 50% of
knowledge of the cirrhotic patient with liver failure, patients within 10 years of the diagnosis of cirrhosis.
sick enough to require admission to hospital. In Most importantly, there is a dramatic worsening of
Europe, this has come from the outstanding work prognosis when this leads to involvement of other
of the Chronic Liver Failure (CLIF) Consortium set organs - multi organ failure (MOF).
up by Rajiv Jalan, Vicente Arroyo, and other leading
[1]
hepatologists to which I will be mainly referring to. Data from a French study as recently as 2014
Shiv Sarin and colleagues in Asia Pacific despite illustrates how poor the outcome has been and
using somewhat different definitions have reported remains so in many hospitals throughout the world
similar findings and for their latest views on acute-on- for cirrhotic patients treated in the intensive care unit
[3]
chronic liver failure (ACLF). I would refer you to the (ICU) and requiring ventilator support. A third only
[2]
excellent review of Sarin and Choudhury in Nature of 246 consecutive patients became well enough to
Reviews Gastroenterology & Hepatology, published be discharged from the ICU and of these less than a
in 2016. The characterisation of a syndrome of ACLF half were alive at 1 year giving a 11% overall survival,
with defined subgroups has led to an improved 10 of the 27 survivors having had a liver transplant.
prognostic assessment and provides a new basis for The factors found to identify the risk of death after
determining selection criteria for liver transplantation discharge, are measures of severity of the liver
(LT) and of measures to enhance recovery from ACLF. damage illness - bilirubin level, high Model for End-
stage Liver Disease (MELD) score, on ventilator for
Some background first, on the massive clinical > 9 days. Almost all of the patients in this study as
problem that hepatology faces from liver failure in they had respiratory failure will have had other organ
Europe: 170,000 European citizens, it is estimated, involvement bringing them within the designation of
die of cirrhosis each year - the 5th most common ACLF.
cause of death in individuals aged 45-65 years.
Clinical decompensation heralded by ascites, The characterisation of ACLF by the CLIF Consortium
hepatic encephalopathy, gastrointestinal bleeding was based on data from the EASL-CLIF Acute-

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