Please use this identifier to cite or link to this item: https://doi.org/10.1007/s12072-019-09946-3
Title: Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update
Authors: Sarin, Shiv Kumar
Choudhury, Ashok
Sharma, Manoj K
Maiwall, Rakhi
Al Mahtab, Mamun
Rahman, Salimur
Saigal, Sanjiv
Saraf, Neeraj
Soin, AS
Devarbhavi, Harshad
Kim, Dong Joon
Dhiman, RK
Duseja, Ajay
Taneja, Sunil
Eapen, CE
Goel, Ashish
Ning, Q
Chen, Tao
Ma, Ke
Duan, Z
Yu, Chen
Treeprasertsuk, Sombat
Hamid, SS
Butt, Amna S
Jafri, Wasim
Shukla, Akash
Saraswat, Vivek
Tan, Soek Siam
Sood, Ajit
Midha, Vandana
Goyal, Omesh
Ghazinyan, Hasmik
Arora, Anil
Hu, Jinhua
Sahu, Manoj
Rao, PN
Lee, Guan H 
Lim, Seng G
Lesmana, Laurentius A
Lesmana, Cosmas Rinaldi
Shah, Samir
Prasad, VG Mohan
Payawal, Diana A
Abbas, Zaigham
Dokmeci, A Kadir
Sollano, Jose D
Carpio, Gian
Shresta, Ananta
Lau, GK
Karim, Md Fazal
Shiha, Gamal
Gani, Rino
Kalista, Kemal Fariz
Yuen, Man-Fung
Alam, Seema
Khanna, Rajeev
Sood, Vikrant
Lal, Bikrant Bihari
Pamecha, Viniyendra
Jindal, Ankur
Rajan, V
Arora, Vinod
Yokosuka, Osamu
Niriella, Madunil A
Li, Hai
Qi, Xiaolong
Tanaka, Atsushi
Mochida, Satoshi
Chaudhuri, Dominic Ray
Gane, Ed
Win, Khin Maung
Chen, Wei Ting
Rela, Mohd
Kapoor, Dharmesh
Rastogi, Amit
Kale, Pratibha
Rastogi, Archana
Sharma, Chhagan Bihari
Bajpai, Meenu
Singh, Virender
Premkumar, Madhumita
Maharashi, Sudhir
Olithselvan, A
Philips, Cyriac Abby
Srivastava, Anshu
Yachha, Surender K
Wani, Zeeshan Ahmad
Thapa, BR
Saraya, Anoop
Shalimar
Kumar, Ashish
Wadhawan, Manav
Gupta, Subash
Madan, Kaushal
Sakhuja, Puja
Vij, Vivek
Sharma, Barjesh C
Garg, Hitendra
Garg, Vishal
Kalal, Chetan
Anand, Lovkesh
Vyas, Tanmay
Mathur, Rajan P
Kumar, Guresh
Jain, Priyanka
Pasupuleti, Samba Siva Rao
Chawla, Yogesh K
Chowdhury, Abhijit
Alam, Shahinul
Song, Do Seon
Yang, Jin Mo
Yoon, Eileen L
Keywords: Science & Technology
Life Sciences & Biomedicine
Gastroenterology & Hepatology
Liver failure
Cirrhosis
Jaundice
AARC
Chronic liver disease
Alcoholic liver disease
ALF
Decompensation
Acute decompensation
HEPATITIS-B-VIRUS
COLONY-STIMULATING FACTOR
EXTRACORPOREAL ALBUMIN DIALYSIS
ACUTE KIDNEY INJURY
INDUCED CIRCULATORY DYSFUNCTION
SYSTEMIC INFLAMMATORY RESPONSE
SEVERE ALCOHOLIC HEPATITIS
RENAL REPLACEMENT THERAPY
G-CSF THERAPY
CIRRHOTIC-PATIENTS
Issue Date: 1-Jul-2019
Publisher: SPRINGER
Citation: Sarin, Shiv Kumar, Choudhury, Ashok, Sharma, Manoj K, Maiwall, Rakhi, Al Mahtab, Mamun, Rahman, Salimur, Saigal, Sanjiv, Saraf, Neeraj, Soin, AS, Devarbhavi, Harshad, Kim, Dong Joon, Dhiman, RK, Duseja, Ajay, Taneja, Sunil, Eapen, CE, Goel, Ashish, Ning, Q, Chen, Tao, Ma, Ke, Duan, Z, Yu, Chen, Treeprasertsuk, Sombat, Hamid, SS, Butt, Amna S, Jafri, Wasim, Shukla, Akash, Saraswat, Vivek, Tan, Soek Siam, Sood, Ajit, Midha, Vandana, Goyal, Omesh, Ghazinyan, Hasmik, Arora, Anil, Hu, Jinhua, Sahu, Manoj, Rao, PN, Lee, Guan H, Lim, Seng G, Lesmana, Laurentius A, Lesmana, Cosmas Rinaldi, Shah, Samir, Prasad, VG Mohan, Payawal, Diana A, Abbas, Zaigham, Dokmeci, A Kadir, Sollano, Jose D, Carpio, Gian, Shresta, Ananta, Lau, GK, Karim, Md Fazal, Shiha, Gamal, Gani, Rino, Kalista, Kemal Fariz, Yuen, Man-Fung, Alam, Seema, Khanna, Rajeev, Sood, Vikrant, Lal, Bikrant Bihari, Pamecha, Viniyendra, Jindal, Ankur, Rajan, V, Arora, Vinod, Yokosuka, Osamu, Niriella, Madunil A, Li, Hai, Qi, Xiaolong, Tanaka, Atsushi, Mochida, Satoshi, Chaudhuri, Dominic Ray, Gane, Ed, Win, Khin Maung, Chen, Wei Ting, Rela, Mohd, Kapoor, Dharmesh, Rastogi, Amit, Kale, Pratibha, Rastogi, Archana, Sharma, Chhagan Bihari, Bajpai, Meenu, Singh, Virender, Premkumar, Madhumita, Maharashi, Sudhir, Olithselvan, A, Philips, Cyriac Abby, Srivastava, Anshu, Yachha, Surender K, Wani, Zeeshan Ahmad, Thapa, BR, Saraya, Anoop, Shalimar, Kumar, Ashish, Wadhawan, Manav, Gupta, Subash, Madan, Kaushal, Sakhuja, Puja, Vij, Vivek, Sharma, Barjesh C, Garg, Hitendra, Garg, Vishal, Kalal, Chetan, Anand, Lovkesh, Vyas, Tanmay, Mathur, Rajan P, Kumar, Guresh, Jain, Priyanka, Pasupuleti, Samba Siva Rao, Chawla, Yogesh K, Chowdhury, Abhijit, Alam, Shahinul, Song, Do Seon, Yang, Jin Mo, Yoon, Eileen L (2019-07-01). Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. HEPATOLOGY INTERNATIONAL 13 (4) : 353-390. ScholarBank@NUS Repository. https://doi.org/10.1007/s12072-019-09946-3
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. With international groups volunteering to join, the “APASL ACLF Research Consortium (AARC)” was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the ‘Golden Therapeutic Window’, extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. 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 and areas requiring future studies are presented here.
Source Title: HEPATOLOGY INTERNATIONAL
URI: https://scholarbank.nus.edu.sg/handle/10635/207636
ISSN: 19360533
19360541
DOI: 10.1007/s12072-019-09946-3
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