Title

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014.

Authors

Shiv Kumar Sarin, Institute of Liver and Biliary Sciences, New DelhiFollow
Chandan Kumar Kedarisetty, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Z Abbas, Agha Khan UniversityFollow
Deepak Amarapurkar, Bombay Hospital and Medical Research, Mumbai, India.
Chhagan Bihari, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Albert C. Chan, The University of Hong Kong, Hong Kong, China.
Yogesh Kumar Chawla, Post Graduate Institute of Medical Education and Research, Chandigarh, India
A. Kadir Dokmeci, Ankara University School of Medicine, Ankara, Turkey.
Hitendra Garg, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Hasmik Ghazinyan, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia.
Saeed Hamid, Aga Khan UniversityFollow
Dong Joon Kim, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, Republic of Korea.
Piyawat Komolmit, Chulalongkorn University, Bangkok, Thailand.
Suman Lata, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Guan Huei Lee, National University Health System, Singapore, Singapore.
Laurentius A, University of Indonesia, Jakarta, Indonesia.
Lesmana L. A, University of Indonesia, Jakarta, Indonesia.
Mamun Mahtab, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Rakhi Maiwall, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Richard Moreau, Centre de recherche sur l'Inflammation (CRI), Paris, France.
Qin Ning, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Viniyendra Pamecha, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Diana Alcantara Payawal, Cardinal Santos Medical Center, Manila, Philippines.
Archana Rastogi, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Salimur Rahman, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Mohamed Rela, Global Health City, Chennai, India.
Anoop Saraya, All India Institute of Medical Sciences, New Delhi, India.
Didier Samuel, Hôpital Paul Brousse, Villejuif, France.
Vivek Saraswat, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Samir Shah, Global Hospitals, Mumbai, India.
Gamal Shiha, Egyptian Liver Research Institute and Hospital, Cairo, Egypt.
Brajesh Chander Sharma, GB Pant Hospital, New Delhi, India.
Manoj j Kumar Sharma, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Kapil Sharma, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Amna Subhan Butt, Agha Khan UniversityFollow
Soek Siam Tan, Selayang Hospital, Kepong, Malaysia.
Chitranshu Vashishtha, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Zeeshan Ahmed Wani, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
Man- Fung Yuen, Graduate School of Medicine, Chiba University, Chiba, Japan.
Osamu Yokosuka, Graduate School of Medicine, Chiba University, Chiba, Japan.

Document Type

Article

Department

Medicine

Comments

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, "APASL ACLF Research Consortium (AARC)," was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here.

Publication

Hepatology international.

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Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.