Portal de Periódicos da CAPES

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

2019; Springer Science+Business Media; Volume: 13; Issue: 4 Linguagem: Inglês

10.1007/s12072-019-09946-3

1936-0541

Shiv Kumar Sarin, Ashok Choudhury, Manoj Kumar, Rakhi Maiwall, Mamun Al Mahtab, Salimur Rahman, Sanjiv Saigal, Neeraj Saraf, Arvinder S. Soin, Harshad Devarbhavi, Dong Joon Kim, Radhakrishan Dhiman, Ajay Duseja, Sunil Taneja, C. E. Eapen, Ashish Goel, Qin Ning, Tao Chen, Ke Ma, Zhongping Duan, Yú Chen, Sombat Treeprasertsuk, Saeed Hamid, Amna S. Butt, Wasim Jafri, Akash Shukla, Vivek A. Saraswat, Soek Siam Tan, Ajit Sood, Vandana Midha, Omesh Goyal, Hasmik Ghazinyan, Anil Arora, Jinhua Hu, Manoj Kumar Sahu, Padaki Nagaraja Rao, Guan Huei Lee, Seng Gee Lim, Laurentius A. Lesmana, Cosmas Rinaldi Adithya Lesmana, Samir Shah, V. G. Mohan Prasad, Diana A. Payawal, Zaigham Abbas, A. Kadir Dökmeci, Jose D. Sollano, Gian Carpio, Ananta Shresta, George Lau, Md. Fazal Karim, Gamal Shiha, Rino Alvani Gani, Kemal Fariz Kalista, Man‐Fung Yuen, Seema Alam, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal, Viniyendra Pamecha, Ankur Jindal, V. Rajan, Vinod Arora, Osamu Yokosuka, Madunil Anuk Niriella, Hai Li, Xiaolong Qi, Atsushi Tanaka, Satoshi Mochida, Dominic Ray Chaudhuri, Ed Gane, Khin Maung Win, Wei Ting Chen, M Rela, Dharmesh Kapoor, Amit Rastogi, Pratibha Kale, Archana Rastogi, Chhagan Bihari Sharma, Meenu Bajpai, Virender Singh, Madhumita Premkumar, Sudhir Maharashi, A. Olithselvan, Cyriac Abby Philips, Anshu Srivastava, Surender Kumar Yachha, Zeeshan Ahmad Wani, B. R. Thapa, Anoop Saraya, S. Shalimar, Ashish Kumar, Manav Wadhawan, Subhash Gupta, Kaushal Madan, Puja Sakhuja, Vivek Vij, Barjesh Chander Sharma, Hitendra Garg, Vishal Garg, Chetan Kalal, Lovkesh Anand, Tanmay Vyas, Rajan P. Mathur, Guresh Kumar, Priyanka Jain, Samba Siva Rao Pasupuleti, Yogesh Chawla, Abhijit Chowdhury, Shahinul Alam, Do Seon Song, Jin Mo Yang, Eileen L. Yoon,

Drug-Induced Hepatotoxicity and Protection

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.