ArticleThe Lancet regional health. Europe2024
Liver transplantation for critically ill patients with acute on chronic liver failure: a prospective national programme of waitlist prioritisation.
Article in The Lancet regional health. Europe, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed.
- Acute-on-Chronic Liver Failure in Severe Alcohol-Associated Hepatitis: Impact on Management, Prognostication, and Urgency of Liver Transplantation.Journal of clinical medicine · 2026Article
- Critical care hepatology: A narrative review of current concepts and management.World journal of critical care medicine · 2026Review
- Comparative Prognostic Performance of Pretransplant AARC, CLIF-C ACLF, and MELD-Na Scores for 90-Day Mortality After Liver Transplantation in Patients With EASL-CLIF Acute-on-Chronic Liver Failure.Annals of transplantation · 2026Observational
- Uncovering immune dysfunction in ACLF: Cellular mechanisms, molecular pathways, and therapeutic frontiers.Journal of hepatology · 2026Review
- Beyond the Tipping Point: Advances in the Diagnosis and Management of Acute-on-Chronic Liver Failure and End-Stage Liver Disease.Diagnostics (Basel, Switzerland) · 2026Review
- Acute-on-chronic liver failure: pathophysiological mechanisms and clinical management.Nature reviews. Gastroenterology & hepatology · 2026Review
- Graft-derived VWF drives platelet activation and thrombocytopenia during porcine liver xenotransplantation to brain-dead human recipients.The Journal of clinical investigation · 2026Article
- Extracorporeal liver cross-circulation using transgenic xenogeneic pig livers with brain-dead human decedents.Nature medicine · 2026Article
- Liver Failure, Hepatic Encephalopathy, and Infection Contribute to Mortality Risk in a Global Cirrhosis Cohort.Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association · 2026Article
- Peak-MELD scores, a disease trajectory associated with reduced access to liver transplantation.Frontiers in medicine · 2026Article
- Acute-on-chronic liver failure.BJA education · 2025Review
- Acute-on-Chronic Liver Failure: Steps Towards Consensus.Diagnostics (Basel, Switzerland) · 2025Review
- Ensuring equity in access to liver transplant for patients with acute-on-chronic liver failure across the UK.The Lancet regional health. Europe · 2025Article
- We need evidence-based futility thresholds to transplant grade-3 acute on chronic liver failure patients with poor respiratory, haemodynamic, and metabolic parameters.The Lancet regional health. Europe · 2025Article
- We need evidence-based futility thresholds to transplant grade-3 acute on chronic liver failure patients with poor respiratory, hemodynamic, and metabolic parameters-authors' reply.The Lancet regional health. Europe · 2025Article
- Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025?Transplant international : official journal of the European Society for Organ Transplantation · 2025Review
- Indian National Association for the Study of Liver (INASL) Guidance Statements for Determining Futility in Liver Transplantation.Journal of clinical and experimental hepatologyReview
Corrections and comments
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Authors and funding
18 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Acute on Chronic Liver Failure (ACLF) complicates chronic liver disease (CLD) combining rapidly progressive hepatic with extra-hepatic multiple organ failure and high short-term mortality. Effective therapeutic options are very limited, and liver transplantation (LT) seldom utilised through concerns of high recipient mortality and resource use. Retrospective reports suggest recent outcomes may have improved, but use of LT for ACLF has not been prospectively assessed. Methods: A prospective programme of prioritised liver graft allocation for selected recipients with ACLF through registration on a new national tier, initiated in May 2021 in all 7 United Kingdom LT centres. Candidates were selected by centre multidisciplinary teams, with inclusion criteria mandating cirrhotic CLD with ACLF requiring critical care (CC) organ support and expected 1-month mortality >50%. Exclusion criteria included age ≥60 years, previous LT, comorbidity or substance misuse profile precluding elective LT. A pilot 50 registrations were planned, with pre-specified futility criteria of a 1-year post-LT survival of 60%. Findings: Fifty-two patients were registered on the ACLF tier, median (IQR) age 46 (39-52) years, ACLF grade 3 (3-3) and Model for End-stage Liver Disease (MELD) 39 (35-40). At registration 32 (62%) required mechanical ventilation, 44 (85%) vasopressors and 46 (89%) renal replacement. Forty-two (81%) underwent LT 2 (2-5) days after registration: 10 (19%) did not. All non-transplanted died at median 7 (4-13) days after registration (p < 0.0001 vs. LT). Post-LT follow-up was 212 (119-530) days and patient survival 81% (95% CI 66-91): 28-, 90-day and 1-year survival after registration 93%, 86% and 77%. Median length of CC and hospital stay in LT recipients was 16 (8-28) and 35 (23-54) days respectively. Interpretation: We report the first prospective national series of prioritised liver transplantation for critically ill patients with ACLF. For selected recipients LT is a practical and highly effective treatment option where no other similarly effective interventions exist. Funding: There was no funding for the study.
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