Liver Transplantation for Acute and Acute on Chronic Liver Failure

Both acute liver failure (ALF) and acute on chronic liver failure (ACLF) are characterized by acute decompensation of the liver function complicated by high morbidity and mortality. In ALF patients, an acute deterioration of the liver function occurs without any pre-existing liver disease, and it may range from mild forms that recover spontaneously to severe forms that progress rapidly with encephalopathy, multiorgan failure, and high mortality. In these severe forms, liver transplantation is indicated and is a life-saving procedure. ACLF is a clinical syndrome with acute deterioration of liver function in patients with cirrhosis complicated by other organ system failures, and high short-term mortality. In the severe forms of ACLF, liver transplantation represents the only effective treatment. Both ALF and ACLF may progress and deteriorate rapidly, therefore, it is critical to proceed with early referral to a liver transplant center, expedite liver transplant evaluation, listing, and prioritization in liver allocation. Outcomes after transplantation depend on proper pre-transplant and perioperative care, patient selection, donor organ selection, early transplantation. Compared to elective liver transplants, transplantation for ALF and ACLF is associated with longer hospital stay, longer intensive care unit stay, higher risk of complications, infections, and mortality.