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Doycheva I, Thuluvath PJ. Acute-on-chronic liver failure in liver transplant candidates with non-alcoholic steatohepatitis. Transl Gastroenterol Hepatol. 2020;5:38doi: 10.21037/tgh.2019.10.01.
Doycheva, I., & Thuluvath, P. J. (2020). Acute-on-chronic liver failure in liver transplant candidates with non-alcoholic steatohepatitis. Translational gastroenterology and hepatology, 538. https://doi.org/10.21037/tgh.2019.10.01
Doycheva, Iliana, and Thuluvath, Paul J. "Acute-on-chronic liver failure in liver transplant candidates with non-alcoholic steatohepatitis." Translational gastroenterology and hepatology vol. 5 (2020): 38. doi: https://doi.org/10.21037/tgh.2019.10.01
Doycheva I, Thuluvath PJ. Acute-on-chronic liver failure in liver transplant candidates with non-alcoholic steatohepatitis. Transl Gastroenterol Hepatol. 2020 Jul 05;5:38. doi: 10.21037/tgh.2019.10.01. eCollection 2020. PMID: 32632389; PMCID: PMC7063516.
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Transl Gastroenterol Hepatol. 2020 Jul 05;5:38. doi: 10.21037/tgh.2019.10.01. eCollection 2020.

Acute-on-chronic liver failure in liver transplant candidates with non-alcoholic steatohepatitis.

Translational gastroenterology and hepatology

Iliana Doycheva, Paul J Thuluvath

Affiliations

  1. Institute for Digestive Heath and Liver Disease, Mercy Medical Center, Baltimore, MD, USA.

PMID: 32632389 PMCID: PMC7063516 DOI: 10.21037/tgh.2019.10.01

Abstract

Non-alcoholic fatty liver disease (NAFLD) has become the most common liver disease worldwide. It is expected that non-alcoholic steatohepatitis (NASH), NASH-related cirrhosis and its decompensated forms will increase further in the next two decades. Acute-on-chronic liver failure (ACLF) is a distinct syndrome characterized by rapid deterioration of liver function in patients with chronic liver disease that is associated with development of one or more organ failures, and carries a very high short-term mortality. There is a paucity of data on ACLF in patients with NASH cirrhosis. Recent studies have shown that although ACLF incidence due to NASH is lower when compared to other etiologies, NASH is the fastest growing liver disease etiology among all ACLF hospitalizations. Higher rates of infections, as a precipitating factor, and circulatory failure were noted in this population. Metabolic derangements such as obesity and diabetes might also play a confounding role in the pathophysiology, clinical course, and prognosis of NASH patients with ACLF. Patients with ACLF due to NASH have shown a lower inpatient mortality despite a longer hospital length-of-stay and a higher 28- and 90-day mortality. Patients with ACLF should be promptly transferred to a transplant center and evaluated for liver transplantation (LT). Optimal prognostic scores, timing of LT, and the best bridge to LT therapy and treatment of post-LT complications need to be elucidated in prospective studies.

2020 Translational Gastroenterology and Hepatology. All rights reserved.

Keywords: Acute-on-chronic liver failure (ACLF); non-alcoholic fatty liver disease (NAFLD); non-alcoholic steatohepatitis (NASH); survival

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

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