JOURNAL OF SHANGHAI JIAOTONG UNIVERSITY (MEDICAL SCIENCE) ›› 2021, Vol. 41 ›› Issue (2): 257-261.doi: 10.3969/j.issn.1674-8115.2021.02.021

• Review • Previous Articles     Next Articles

Research progress in liver transplantation for acute-on-chronic liver failure

Tian-yi ZHANG(), Ye-ping YU, Qiang XIA, Hua-lian HANG()   

  1. Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
  • Received:2020-06-01 Online:2021-02-28 Published:2021-02-28
  • Contact: Hua-lian HANG;
  • Supported by:
    National Natural Science foundation of China(81570561);Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support(20181806);The Most Important Clinical Medical Center in Shanghai(2017ZZ01018);Shanghai Jiao Tong University Medical Engineering Cross Grant(YG2021ZD10)


Acute-on-chronic liver failure (ACLF), caused by various factors, is a rapid decompensation of liver function based on chronic liver disease, which is often accompanied by multiple organ failure and high short-term mortality. So far, there is no effective treatment except liver transplantation, which is the only possible cure. The evaluation before surgery is critical. Due to the large amount of hepatitis B virus (HBV) patients in our country, the evaluation of HBV-related ACLF (HBV-ACLF) is important. Systems like COSSH-ACLF, and CLIF-ACLF could be used for the evaluation. For the timing of surgery, transplantation at the state of ACLF-2 may have more benefit for patients but the conclusion need more research to prove. During the perioperative period, management of organ failure and basic disease is needed. The timing of dissociation of the receptor and trimming of the donor need to be carefully managed during the surgery. After the surgery, beside the usual complication of liver transplantation, events such as infection, organ failure, hepatic encephalopathy should be dealt with. The condition of organ failures before and after liver transplantation is associated with the long-term mortality of patients.This article aims to make review on the assessment before liver transplantation, timing of transplantation, perioperative management, notice during surgery and complication after surgery based on massive clinical experience and plenty of document readings.

Key words: acute-on-chronic liver failure (ACLF), liver transplantation, multiple organ failure, mortality rate, complication

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