ArticleHepatology international2021
'First week' is the crucial period for deciding living donor liver transplantation in patients with acute-on-chronic liver failure.
Article in Hepatology international, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers, 1 of them a synthesis that pooled it.
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Who cites it
15 citing papers in PubMed, 1 synthesis or guideline pooled it, 24 citations in OpenAlex.
- APASL clinical practice guidelines on the management of acute kidney injury in acute-on-chronic liver failure.Hepatology international · 2024Guideline
- The Global ACLF Consensus : the 'Istanbul Document'.Hepatology international · 2026Article
- Acute-on-chronic liver failure: pathophysiological mechanisms and clinical management.Nature reviews. Gastroenterology & hepatology · 2026Review
- Tracking the trajectory of kidney dysfunction in cirrhosis: the acute kidney injury: chronic kidney disease spectrum.Clinical and molecular hepatology · 2025Review
- Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia.Hepatology international · 2025Review
- From prognostication to therapeutics: Four key questions to accelerate the development of therapeutics for patients with acute-on-chronic liver failure.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2024Article
- Common definitions and variables are needed for the United States to join the conversation on acute-on-chronic liver failure.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2024Article
- Acute decompensation of cirrhosis versus acute-on-chronic liver failure: What are the clinical implications?United European gastroenterology journal · 2024Review
- Healthcare utilization and outcomes of living donor liver transplantation for patients with APASL-defined acute-on-chronic liver failure.Hepatology international · 2023Article
- PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit.Hepatology international · 2023Article
- Pathophysiology and management of liver cirrhosis: from portal hypertension to acute-on-chronic liver failure.Frontiers in medicine · 2023Review
- Transplantation in Acute-on-Chronic Liver Failure: Feasibility and Futility.Clinical liver disease · 2022Review
- Indian National Association for the Study of Liver (INASL) Guidance Statements for Determining Futility in Liver Transplantation.Journal of clinical and experimental hepatologyReview
- Liver Transplantation: Protocol for Recipient Selection, Evaluation, and Assessment.Journal of clinical and experimental hepatologyReview
- Liver Transplantation in Chronic Liver Disease and Acute on Chronic Liver Failure- Indication, Timing and Practices.Journal of clinical and experimental hepatologyReview
Corrections and comments
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Authors and funding
48 authors at 20 institutions in 12 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsAcute-on-chronic liver failure (ACLF) is a rapidly progressive illness with high short-term mortality. Timely liver transplant (LT) may improve survival. We evaluated various indices for assessment of the severity of liver failure and their application for eligibility and timing of living donor LT (LDLT).
methodsAltogether 1021 patients were analyzed for the severity and organ failure at admission to determine transplant eligibility and 28 day survival with or without transplant.
resultsThe ACLF cohort [mean age 44 ± 12.2 years, males 81%) was of sick patients; 55% willing for LT at admission, though 63% of them were ineligible due to sepsis or organ failure. On day 4, recovery in sepsis and/or organ failure led to an improvement in transplant eligibility from 37% at baseline to 63.7%. Delay in LT up to 7 days led to a higher incidence of multiorgan failure (p < 0.01) contributing to 23% of the first week and 55% of all-cause 28-day mortality. In a matched cohort analysis, the actuarial survival with LT (n = 41) and conditional survival in the absence of transplant (n = 191) were comparable, when the condition, i.e., transplant was adjusted. The comparison curve showed differentiation in survival beyond 7 days (p < 0.01).
conclusionsACLF is a rapidly progressive disease and risk stratification within the first week of hospitalization is needed. 'Emergent LT' should be defined in the first week in the ACLF patients; the transplant window for improving survival in a live donor setting.
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