| Literature DB >> 31172417 |
Shiv Kumar Sarin1, Ashok Choudhury2, Manoj K Sharma2, Rakhi Maiwall2, Mamun Al Mahtab3, Salimur Rahman3, Sanjiv Saigal4, Neeraj Saraf4, A S Soin4, Harshad Devarbhavi5, Dong Joon Kim6, R K Dhiman7, Ajay Duseja7, Sunil Taneja7, C E Eapen8, Ashish Goel8, Q Ning9, Tao Chen10, Ke Ma9, Z Duan10, Chen Yu10, Sombat Treeprasertsuk11, S S Hamid12, Amna S Butt12, Wasim Jafri12, Akash Shukla13, Vivek Saraswat14, Soek Siam Tan15, Ajit Sood16, Vandana Midha16, Omesh Goyal16, Hasmik Ghazinyan17, Anil Arora18, Jinhua Hu19, Manoj Sahu20, P N Rao21, Guan H Lee22, Seng G Lim22, Laurentius A Lesmana23, Cosmas Rinaldi Lesmana23, Samir Shah24, V G Mohan Prasad25, Diana A Payawal26, Zaigham Abbas27, A Kadir Dokmeci28, Jose D Sollano29, Gian Carpio29, Ananta Shresta30, G K Lau31, Md Fazal Karim32, Gamal Shiha33, Rino Gani34, Kemal Fariz Kalista34, Man-Fung Yuen35, Seema Alam36, Rajeev Khanna36, Vikrant Sood36, Bikrant Bihari Lal36, Viniyendra Pamecha37, Ankur Jindal2, V Rajan2, Vinod Arora2, Osamu Yokosuka38, Madunil A Niriella39, Hai Li40, Xiaolong Qi41, Atsushi Tanaka42, Satoshi Mochida43, Dominic Ray Chaudhuri44, Ed Gane44, Khin Maung Win45, Wei Ting Chen46, Mohd Rela47, Dharmesh Kapoor24, Amit Rastogi4, Pratibha Kale48, Archana Rastogi49, Chhagan Bihari Sharma49, Meenu Bajpai50, Virender Singh7, Madhumita Premkumar7, Sudhir Maharashi51, A Olithselvan52, Cyriac Abby Philips53, Anshu Srivastava54, Surender K Yachha54, Zeeshan Ahmad Wani55, B R Thapa56, Anoop Saraya57, Ashish Kumar18, Manav Wadhawan58, Subash Gupta59, Kaushal Madan60, Puja Sakhuja61, Vivek Vij62, Barjesh C Sharma63, Hitendra Garg64, Vishal Garg64, Chetan Kalal65, Lovkesh Anand66, Tanmay Vyas67, Rajan P Mathur68, Guresh Kumar69, Priyanka Jain69, Samba Siva Rao Pasupuleti69, Yogesh K Chawla70, Abhijit Chowdhury71, Shahinul Alam3, Do Seon Song72, Jin Mo Yang72, Eileen L Yoon73.
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.Entities:
Keywords: AARC; ALF; Acute decompensation; Alcoholic liver disease; Chronic liver disease; Cirrhosis; Decompensation; Jaundice; Liver failure
Mesh：
Year: 2019 PMID： 31172417 PMCID： PMC6728300 DOI： 10.1007/s12072-019-09946-3
Source DB: PubMed Journal: Hepatol Int ISSN： 1936-0533 Impact factor: 6.047