Novel Therapeutic Approaches in Treatment of Acute-on-Chronic Liver Failure

MohammadMahdi Saeidinejad; Ahmed Elshabrawi; Supachaya Sriphoosanaphan; Fausto Andreola; Gautam Mehta; Banwari Agarwal; Rajiv Jalan

doi:10.1055/s-0043-1776773

Seminars in Liver Disease, Inhaltsverzeichnis

CC BY 4.0 · Semin Liver Dis 2023; 43(04): 429-445
DOI: 10.1055/s-0043-1776773

Review Article

Novel Therapeutic Approaches in Treatment of Acute-on-Chronic Liver Failure

MohammadMahdi Saeidinejad

¹Liver Failure Group, Department of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom

,

Ahmed Elshabrawi

¹Liver Failure Group, Department of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom

²Intensive Care Unit, Endemic Hepatology and Gastroenterology Department, Mansoura University, Mansoura, Egypt

,

Supachaya Sriphoosanaphan

¹Liver Failure Group, Department of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom

³Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok

,

Fausto Andreola

¹Liver Failure Group, Department of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom

,

Gautam Mehta

¹Liver Failure Group, Department of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom

,

Banwari Agarwal

¹Liver Failure Group, Department of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom

⁴Intensive Care Unit, Royal Free Hospital, London, United Kingdom

,

Rajiv Jalan

¹Liver Failure Group, Department of Medicine, Institute for Liver and Digestive Health, University College London, London, United Kingdom

⁵Hepatology Department, Royal Free Hospital, London, United Kingdom

⁶European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain

› Institutsangaben

Abstract

Acute-on-chronic liver failure (ACLF), a clinical syndrome that can develop at any stage in the progression of cirrhotic liver disease, is characterized by an acute decompensation in liver function with associated multiorgan failure and high short-term mortality. Current evidence points to ACLF being reversible, particularly in those at the lower end of the severity spectrum. However, there are no specific treatments for ACLF, and overall outcomes remain poor. Expedited liver transplantation as a treatment option is limited by organ shortage and a lack of priority allocation for this indication. Other options are therefore urgently needed, and our improved understanding of the condition has led to significant efforts to develop novel therapies. In conclusion, this review aims to summarize the current understanding of the pathophysiological processes involved in the onset, progression, and recovery of ACLF and discuss novel therapies under development.

Keywords

cirrhosis - ACLF - Inflammation

Volltext

Referenzen

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