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Open Access 17-02-2025 | Gastrointestinal Emergency | Consensus

Acute-on-chronic liver failure (ACLF): the ‘Kyoto Consensus’—steps from Asia

Authors: Ashok Choudhury, Anand V. Kulkarni, Vinod Arora, A. S. Soin, Abdul Kadir Dokmeci, Abhijeet Chowdhury, Abraham Koshy, Ajay Duseja, Ajay Kumar, Ajay Kumar Mishra, Ajay Kumar Patwa, Ajit Sood, Akash Roy, Akash Shukla, Albert Chan, Aleksander Krag, Amar Mukund, Ameet Mandot, Amit Goel, Amna Subhan Butt, Amrish Sahney, Ananta Shrestha, Andrés Cárdenas, Angelo Di Giorgio, Anil Arora, Anil Chandra Anand, Anil Dhawan, Ankur Jindal, Anoop Saraya, Anshu Srivastava, Anupam Kumar, Apichat Kaewdech, Apurva Pande, Archana Rastogi, Arun Valsan, Ashish Goel, Ashish Kumar, Ashwani K. Singal, Atsushi Tanaka, Audrey Coilly, Ayaskanta Singh, Babu Lal Meena, Barath Jagadisan, Barjesh Chander Sharma, Bikrant Bihari Lal, C. E. Eapen, Cesar Yaghi, Chandan Kumar Kedarisetty, Chang Wook Kim, Charles Panackel, Chen Yu, Chetan R. Kalal, Chhagan Bihari, Chien Hao Huang, Chitranshu Vasishtha, Christian Jansen, Christian Strassburg, Chun Yen Lin, Constantine J. Karvellas, Cosmas Rinaldi Adithya Lesmana, Cyriac Abby Philips, Debbie Shawcross, Dharmesh Kapoor, Dhiraj Agrawal, Diana Alcantara Payawal, Dibya Lochan Praharaj, Dinesh Jothimani, Do Seon Song, Dong Joon Kim, Dong-Sik Kim, Duan Zhongping, Fazal Karim, Francois Durand, Gamal E. Shiha, Gennaro D’Amico, George K. Lau, Girish Kumar Pati, Graciela Elia Castro Narro, Guan-Huei Lee, Gupse Adali, Guru Prasad Dhakal, Gyongyi Szabo, H. C. Lin, Hai Li, Hari Kumar Nair, Harshad Devarbhavi, Harshvardhan Tevethia, Hasmik Ghazinian, Hemamala Ilango, Hong Ling Yu, Irsan Hasan, J. Fernandez, Jacob George, Jaideep Behari, James Fung, Jasmohan Bajaj, Jaya Benjamin, Jennifer C. Lai, Jidong Jia, Jin Hua Hu, Jin Jun Chen, Jin Lin Hou, Jin Mo Yang, Johannes Chang, Jonel Trebicka, Jörg C. Kalf, Jose D. Sollano, Joy Varghese, Juan Pablo Arab, Jun Li, K. Rajender Reddy, Kaiser Raja, Kalpana Panda, Kamal Kajal, Karan Kumar, Kaushal Madan, Kemal Fariz Kalista, Kessarin Thanapirom, Khin Maung Win, Ki Tae Suk, Krishnadas Devadas, Laurentius A. Lesmana, Lubna Kamani, Madhumita Premkumar, Madunil A. Niriella, Mamun Al Mahtab, Man Fung Yuen, Manal HEl Sayed, Manasa Alla, Manav Wadhawan, Manoj Kumar Sharma, Manoj Sahu, Manya Prasad, Mark Dhinesh Muthiah, Martin Schulz, Meenu Bajpai, Mettu Srinivas Reddy, Michael Praktiknjo, Ming Lung Yu, Mithra Prasad, Mithun Sharma, Mohamed Elbasiony, Mohammed Eslam, Mohd. Golam Azam, Mohd. Rela, Moreshwar S. Desai, Mukul Vij, Nadim Mahmud, Narendra Singh Choudhary, Navin Kumar Marannan, Necati Ormeci, Neeraj Saraf, Nipun Verma, Nobuaki Nakayama, Norifumi Kawada, Oidov Baatarkhuu, Omesh Goyal, Osamu Yokosuka, P. N. Rao, Paolo Angeli, Pathik Parikh, Patrick S. Kamath, Paul J. Thuluvath, Philipp Lingohr, Piyush Ranjan, Prashant Bhangui, Pravin Rathi, Puja Sakhuja, Puneet Puri, Qin Ning, R. K. Dhiman, Rahul Kumar, Rajan Vijayaraghavan, Rajeev Khanna, Rakhi Maiwall, Ravi Mohanka, Richard Moreau, Rino Alvani Gani, Rohit Loomba, Rohit Mehtani, Ruveena Bhavani Rajaram, S. S. Hamid, Sachin Palnitkar, Sadhna Lal, Sagnik Biswas, Sakkarin Chirapongsathorn, Samagra Agarwal, Sanjeev Sachdeva, Sanjiv Saigal, Santhosh E. Kumar, Sargsyan Violeta, Satender Pal Singh, Satoshi Mochida, Saurabh Mukewar, Seema Alam, Seng Gee Lim, Shahinul Alam, Shalimar, Shantan Venishetty, Shikha S. Sundaram, Shiran Shetty, Shobna Bhatia, Shweta A. Singh, Shyam Kottilil, Simone Strasser, S. M. Shasthry, Soe Thiha Maung, Soek Siam Tan, Sombat Treeprasertsuk, Sonal Asthana, Steffen Manekeller, Subhash Gupta, Subrat Kumar Acharya, Sudhamshu K.C., Sudhir Maharshi, Sumeet Asrani, Sunil Dadhich, Sunil Taneja, Suprabhat Giri, Surender Singh, Tao Chen, Tarana Gupta, Tatsuo Kanda, Tawesak Tanwandee, Teerha Piratvishuth, Ulrich Spengler, V. G. Mohan Prasad, Vandana Midha, Venera Rakhmetova, Vicente Arroyo, Vikrant Sood, Vinay Kumar BR, Vincent Wai-Sun Wong, Viniyendra Pamecha, Virendra Singh, Vishwa Mohan Dayal, Vivek A. Saraswat, WRay Kim, Wasim Jafri, Wenyi Gu, Wong Yu Jun, Xiaolong Qi, Yogesh K. Chawla, Yoon Jun Kim, Yu Shi, Zaigham Abbas, Guresh Kumar, Shuichiro Shiina, Lai Wei, Masao Omata, Shiv Kumar Sarin, APASL-ACLF Research Consortium (AARC) for APASL-ACLF working party

Published in: Hepatology International | Issue 1/2025

Abstract

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the “APASL ACLF Research Consortium (AARC)” was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia–Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the ‘Golden Therapeutic Window’, the ‘transplant window’, and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The ‘Kyoto APASL Consensus’ presented below carries the final recommendations along with the relevant background information and areas requiring future studies.

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Title: Acute-on-chronic liver failure (ACLF): the ‘Kyoto Consensus’—steps from Asia
Authors: Ashok Choudhury
Anand V. Kulkarni
Vinod Arora
A. S. Soin
Abdul Kadir Dokmeci
Abhijeet Chowdhury
Abraham Koshy
Ajay Duseja
Ajay Kumar
Ajay Kumar Mishra
Ajay Kumar Patwa
Ajit Sood
Akash Roy
Akash Shukla
Albert Chan
Aleksander Krag
Amar Mukund
Ameet Mandot
Amit Goel
Amna Subhan Butt
Amrish Sahney
Ananta Shrestha
Andrés Cárdenas
Angelo Di Giorgio
Anil Arora
Anil Chandra Anand
Anil Dhawan
Ankur Jindal
Anoop Saraya
Anshu Srivastava
Anupam Kumar
Apichat Kaewdech
Apurva Pande
Archana Rastogi
Arun Valsan
Ashish Goel
Ashish Kumar
Ashwani K. Singal
Atsushi Tanaka
Audrey Coilly
Ayaskanta Singh
Babu Lal Meena
Barath Jagadisan
Barjesh Chander Sharma
Bikrant Bihari Lal
C. E. Eapen
Cesar Yaghi
Chandan Kumar Kedarisetty
Chang Wook Kim
Charles Panackel
Chen Yu
Chetan R. Kalal
Chhagan Bihari
Chien Hao Huang
Chitranshu Vasishtha
Christian Jansen
Christian Strassburg
Chun Yen Lin
Constantine J. Karvellas
Cosmas Rinaldi Adithya Lesmana
Cyriac Abby Philips
Debbie Shawcross
Dharmesh Kapoor
Dhiraj Agrawal
Diana Alcantara Payawal
Dibya Lochan Praharaj
Dinesh Jothimani
Do Seon Song
Dong Joon Kim
Dong-Sik Kim
Duan Zhongping
Fazal Karim
Francois Durand
Gamal E. Shiha
Gennaro D’Amico
George K. Lau
Girish Kumar Pati
Graciela Elia Castro Narro
Guan-Huei Lee
Gupse Adali
Guru Prasad Dhakal
Gyongyi Szabo
H. C. Lin
Hai Li
Hari Kumar Nair
Harshad Devarbhavi
Harshvardhan Tevethia
Hasmik Ghazinian
Hemamala Ilango
Hong Ling Yu
Irsan Hasan
J. Fernandez
Jacob George
Jaideep Behari
James Fung
Jasmohan Bajaj
Jaya Benjamin
Jennifer C. Lai
Jidong Jia
Jin Hua Hu
Jin Jun Chen
Jin Lin Hou
Jin Mo Yang
Johannes Chang
Jonel Trebicka
Jörg C. Kalf
Jose D. Sollano
Joy Varghese
Juan Pablo Arab
Jun Li
K. Rajender Reddy
Kaiser Raja
Kalpana Panda
Kamal Kajal
Karan Kumar
Kaushal Madan
Kemal Fariz Kalista
Kessarin Thanapirom
Khin Maung Win
Ki Tae Suk
Krishnadas Devadas
Laurentius A. Lesmana
Lubna Kamani
Madhumita Premkumar
Madunil A. Niriella
Mamun Al Mahtab
Man Fung Yuen
Manal HEl Sayed
Manasa Alla
Manav Wadhawan
Manoj Kumar Sharma
Manoj Sahu
Manya Prasad
Mark Dhinesh Muthiah
Martin Schulz
Meenu Bajpai
Mettu Srinivas Reddy
Michael Praktiknjo
Ming Lung Yu
Mithra Prasad
Mithun Sharma
Mohamed Elbasiony
Mohammed Eslam
Mohd. Golam Azam
Mohd. Rela
Moreshwar S. Desai
Mukul Vij
Nadim Mahmud
Narendra Singh Choudhary
Navin Kumar Marannan
Necati Ormeci
Neeraj Saraf
Nipun Verma
Nobuaki Nakayama
Norifumi Kawada
Oidov Baatarkhuu
Omesh Goyal
Osamu Yokosuka
P. N. Rao
Paolo Angeli
Pathik Parikh
Patrick S. Kamath
Paul J. Thuluvath
Philipp Lingohr
Piyush Ranjan
Prashant Bhangui
Pravin Rathi
Puja Sakhuja
Puneet Puri
Qin Ning
R. K. Dhiman
Rahul Kumar
Rajan Vijayaraghavan
Rajeev Khanna
Rakhi Maiwall
Ravi Mohanka
Richard Moreau
Rino Alvani Gani
Rohit Loomba
Rohit Mehtani
Ruveena Bhavani Rajaram
S. S. Hamid
Sachin Palnitkar
Sadhna Lal
Sagnik Biswas
Sakkarin Chirapongsathorn
Samagra Agarwal
Sanjeev Sachdeva
Sanjiv Saigal
Santhosh E. Kumar
Sargsyan Violeta
Satender Pal Singh
Satoshi Mochida
Saurabh Mukewar
Seema Alam
Seng Gee Lim
Shahinul Alam
Shalimar
Shantan Venishetty
Shikha S. Sundaram
Shiran Shetty
Shobna Bhatia
Shweta A. Singh
Shyam Kottilil
Simone Strasser
S. M. Shasthry
Soe Thiha Maung
Soek Siam Tan
Sombat Treeprasertsuk
Sonal Asthana
Steffen Manekeller
Subhash Gupta
Subrat Kumar Acharya
Sudhamshu K.C.
Sudhir Maharshi
Sumeet Asrani
Sunil Dadhich
Sunil Taneja
Suprabhat Giri
Surender Singh
Tao Chen
Tarana Gupta
Tatsuo Kanda
Tawesak Tanwandee
Teerha Piratvishuth
Ulrich Spengler
V. G. Mohan Prasad
Vandana Midha
Venera Rakhmetova
Vicente Arroyo
Vikrant Sood
Vinay Kumar BR
Vincent Wai-Sun Wong
Viniyendra Pamecha
Virendra Singh
Vishwa Mohan Dayal
Vivek A. Saraswat
WRay Kim
Wasim Jafri
Wenyi Gu
Wong Yu Jun
Xiaolong Qi
Yogesh K. Chawla
Yoon Jun Kim
Yu Shi
Zaigham Abbas
Guresh Kumar
Shuichiro Shiina
Lai Wei
Masao Omata
Shiv Kumar Sarin
APASL-ACLF Research Consortium (AARC) for APASL-ACLF working party
Publication date: 17-02-2025
Publisher: Springer India
Keywords: Gastrointestinal Emergency
Liver Cirrhosis
Acute Liver Failure
Liver Transplantation
Ascites
Hepatic Encephalopathy
Esophageal Varices
Fundus Varices
Corpus Varices
Published in: Hepatology International / Issue 1/2025
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI: https://doi.org/10.1007/s12072-024-10773-4

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Rheumatoid factor levels indicate cryoglobulinemia severity in hepatitis B e antigen-negative hepatitis B virus carriers: a 7-year prospective cohort study

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Abstract

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Rheumatoid factor levels indicate cryoglobulinemia severity in hepatitis B e antigen-negative hepatitis B virus carriers: a 7-year prospective cohort study

AARC score and urine NGAL predict terlipressin non-response and mortality in patients with acute-on-chronic liver failure

Key considerations in portal vein thrombosis management

Impact of graft type on outcomes following liver transplantation for primary sclerosing cholangitis

Appendicular skeletal muscle mass is associated with metabolic dysfunction-associated steatotic liver disease severity in young men: a cross-sectional and longitudinal study

Treatment of portal vein thrombosis in cirrhosis is associated with no survival advantage: a retrospective controlled study