Journal
EXPERT REVIEW OF GASTROENTEROLOGY & HEPATOLOGY
Volume 16, Issue 7, Pages 639-652Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1080/17474124.2022.2097070
Keywords
Inflammatory response; Acute-on-chronic liver failure; liver transplantation; acute decompensation; multiorgan failure
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Acute-on-chronic liver failure (ACLF) is a recognized syndrome in patients with chronic liver disease, characterized by acute decompensation, organ failure(s), and high short-term mortality. There are currently no specific targeted treatments for ACLF, with management focusing on treating underlying precipitants and providing organ support.
Introduction Acute-on-chronic failure (ACLF) is a recognized syndrome in patients with chronic liver disease and is characterized by acute decompensation, organ failure(s), and a high short-term mortality. ACLF is often triggered by ongoing alcohol consumption, gastrointestinal bleeding and/or infections, and is pathophysiologically characterized by uncontrolled systemic inflammation coupled with paradoxical immunoparesis. Patients with ACLF require prompt and early recognition. Management requires extensive utilization of clinical resources often including escalation to intensive care. Areas covered Currently, there are no specific targeted treatments for established ACLF, and management revolves around treating underlying precipitants and providing organ support. In this article, we review the epidemiology and pathophysiology of ACLF and summarize recent advances in management strategies of this syndrome, focusing specifically on novel emerging therapies. Expert commentary ACLF is a challenging condition with rapid clinical course, high short-term mortality and varying clinical phenotypes. Management of ACLF is broadly focused on supportive care often in an intensive care setting with liver transplantation proving to be an increasingly relevant and effective rescue therapy. This disease has clear pathogenesis and epidemiological burden, thus distinguishing it from decompensated cirrhosis; there is clear clinical need for the development of specific and nuanced therapies to treat this condition.
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