Acute-on-chronic liver failure

consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.

Research output: Contribution to journalArticleResearchpeer-review

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.

Original languageEnglish
JournalHepatology International
DOIs
Publication statusPublished - 1 Jan 2019

Fingerprint

Liver
Research
Liver Failure
Sepsis
Databases
Renal Replacement Therapy
Acute-On-Chronic Liver Failure
Gastroenterology
Liver Transplantation
Antiviral Agents
Research Personnel
Pediatrics
Therapeutics

Keywords

  • AARC
  • Acute decompensation
  • Alcoholic liver disease
  • ALF
  • Chronic liver disease
  • Cirrhosis
  • Decompensation
  • Jaundice
  • Liver failure

Cite this

@article{7beccca93b6c4039bdb96dbfbf71ba02,
title = "Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update",
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.",
keywords = "AARC, Acute decompensation, Alcoholic liver disease, ALF, Chronic liver disease, Cirrhosis, Decompensation, Jaundice, Liver failure",
author = "{APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.} and Sarin, {Shiv Kumar} and Ashok Choudhury and Sharma, {Manoj K.} and Rakhi Maiwall and {Al Mahtab}, Mamun and Salimur Rahman and Sanjiv Saigal and Neeraj Saraf and Soin, {A. S.} and Harshad Devarbhavi and Kim, {Dong Joon} and Dhiman, {R. K.} and Ajay Duseja and Sunil Taneja and Eapen, {C. E.} and Ashish Goel and Q. Ning and Tao Chen and Ke Ma and Z. Duan and Chen Yu and Sombat Treeprasertsuk and Hamid, {S. S.} and Butt, {Amna S.} and Wasim Jafri and Akash Shukla and Vivek Saraswat and Tan, {Soek Siam} and Ajit Sood and Vandana Midha and Omesh Goyal and Hasmik Ghazinyan and Anil Arora and Jinhua Hu and Manoj Sahu and Rao, {P. N.} and Lee, {Guan H.} and Lim, {Seng G.} and Lesmana, {Laurentius A.} and Lesmana, {Cosmas Rinaldi} and Samir Shah and Prasad, {V. G.Mohan} and Payawal, {Diana A.} and Zaigham Abbas and Dokmeci, {A. Kadir} and Sollano, {Jose D.} and Gian Carpio and Ananta Shresta and Lau, {G. K.} and Rino Gani",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s12072-019-09946-3",
language = "English",
journal = "Hepatology International",
issn = "1936-0533",
publisher = "Springer New York",

}

Acute-on-chronic liver failure : consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. / APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.

In: Hepatology International, 01.01.2019.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Acute-on-chronic liver failure

T2 - consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

AU - APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.

AU - Sarin, Shiv Kumar

AU - Choudhury, Ashok

AU - Sharma, Manoj K.

AU - Maiwall, Rakhi

AU - Al Mahtab, Mamun

AU - Rahman, Salimur

AU - Saigal, Sanjiv

AU - Saraf, Neeraj

AU - Soin, A. S.

AU - Devarbhavi, Harshad

AU - Kim, Dong Joon

AU - Dhiman, R. K.

AU - Duseja, Ajay

AU - Taneja, Sunil

AU - Eapen, C. E.

AU - Goel, Ashish

AU - Ning, Q.

AU - Chen, Tao

AU - Ma, Ke

AU - Duan, Z.

AU - Yu, Chen

AU - Treeprasertsuk, Sombat

AU - Hamid, S. S.

AU - Butt, Amna S.

AU - Jafri, Wasim

AU - Shukla, Akash

AU - Saraswat, Vivek

AU - Tan, Soek Siam

AU - Sood, Ajit

AU - Midha, Vandana

AU - Goyal, Omesh

AU - Ghazinyan, Hasmik

AU - Arora, Anil

AU - Hu, Jinhua

AU - Sahu, Manoj

AU - Rao, P. N.

AU - Lee, Guan H.

AU - Lim, Seng G.

AU - Lesmana, Laurentius A.

AU - Lesmana, Cosmas Rinaldi

AU - Shah, Samir

AU - Prasad, V. G.Mohan

AU - Payawal, Diana A.

AU - Abbas, Zaigham

AU - Dokmeci, A. Kadir

AU - Sollano, Jose D.

AU - Carpio, Gian

AU - Shresta, Ananta

AU - Lau, G. K.

AU - Gani, Rino

PY - 2019/1/1

Y1 - 2019/1/1

N2 - 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.

AB - 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.

KW - AARC

KW - Acute decompensation

KW - Alcoholic liver disease

KW - ALF

KW - Chronic liver disease

KW - Cirrhosis

KW - Decompensation

KW - Jaundice

KW - Liver failure

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U2 - 10.1007/s12072-019-09946-3

DO - 10.1007/s12072-019-09946-3

M3 - Article

JO - Hepatology International

JF - Hepatology International

SN - 1936-0533

ER -