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

Sarin SK 1 , Kedarisetty CK 2 , Abbas Z 3 , Amarapurkar D 4 , Bihari C 5 , Chan AC 6 Show all authors , Chawla YK 7 , Dokmeci AK 8 , Garg H 2 , Ghazinyan H 9 , Hamid S 10 , Kim DJ 11 , Komolmit P 12 , Lata S 13 , Lee GH 14 , Lesmana LA 15 , Mahtab M 16 , Maiwall R 2 , Moreau R 17 , Ning Q 18 , Pamecha V 19 , Payawal DA 20 , Rastogi A 5 , Rahman S 16 , Rela M 21 , Saraya A 22 , Samuel D 23 , Saraswat V 24 , Shah S 25 , Shiha G 26 , Sharma BC 27 , Sharma MK 2 , Sharma K 2 , Butt AS 10 , Tan SS 28 , Vashishtha C 2 , Wani ZA 2 , Yuen MF 29 , Yokosuka O 30 , APASL ACLF Working Party

Affiliations 

  • 1 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. [email protected]
  • 2 Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 3 Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
  • 4 Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research, Mumbai, India
  • 5 Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 6 Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China
  • 7 Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 8 Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
  • 9 Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
  • 10 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 11 Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do, Republic of Korea
  • 12 Division of Gastroenterology and Hepatology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
  • 13 Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 14 Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
  • 15 Division of Hepatology, University of Indonesia, Jakarta, Indonesia
  • 16 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 17 Inserm, U1149, Centre de recherche sur l'Inflammation (CRI), Paris, France
  • 18 Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  • 19 Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, 110070, India
  • 20 Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines
  • 21 Institute of Liver Diseases and Transplantation, Global Health City, Chennai, India
  • 22 Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
  • 23 INSERM, Centre Hépatobiliarie, Hôpital Paul Brousse, Villejuif, France
  • 24 Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
  • 25 Department of Gastroenterology and Hepatology, Global Hospitals, Mumbai, India
  • 26 Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt
  • 27 Department of Gastroenterology, GB Pant Hospital, New Delhi, India
  • 28 Department of Gastroenterology and Hepatology, Selayang Hospital, Kepong, Malaysia
  • 29 Department of Medicine, The University of Hong Kong, Hong Kong, China
  • 30 Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan
Hepatol Int, 2014 Oct;8(4):453-71.
PMID: 26202751 DOI: 10.1007/s12072-014-9580-2

Abstract

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.

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