New Concepts in Acute-on-Chronic Liver Failure: Implications for Liver Transplantation

被引:45
作者
Putignano, Antonella [1 ]
Gustot, Thierry [1 ,2 ,3 ,4 ]
机构
[1] CUB Erasme Hosp, Dept Gastroenterol & Hepatopancreatol, 808 Route Lennik, B-1070 Brussels, Belgium
[2] Univ Libre Bruxelles, Lab Expt Gastroenterol, Brussels, Belgium
[3] Ctr Rech Inflammat Paris, Unite 1149, INSERM, Paris, France
[4] Univ Paris Diderot, Unite Mixtes Rech Sante 1149, Paris, France
关键词
SEVERE ALCOHOLIC HEPATITIS; SINGLE-CENTER EXPERIENCE; CHRONIC KIDNEY-DISEASE; WAITING-LIST; MELD SCORE; SURVIVAL; ALLOCATION; PROGNOSIS; MORTALITY; OUTCOMES;
D O I
10.1002/lt.24654
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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.
引用
收藏
页码:234 / 243
页数:10
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