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Hepatology International
Published in: Hepatology International 4/2019

Open Access 01-07-2019 | Hepatic Encephalopathy | Guidelines

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

Authors: Shiv Kumar Sarin, Ashok Choudhury, Manoj K. Sharma, Rakhi Maiwall, Mamun Al Mahtab, Salimur Rahman, Sanjiv Saigal, Neeraj Saraf, A. S. Soin, Harshad Devarbhavi, Dong Joon Kim, R. K. Dhiman, Ajay Duseja, Sunil Taneja, C. E. Eapen, Ashish Goel, Q. Ning, Tao Chen, Ke Ma, Z. Duan, Chen Yu, Sombat Treeprasertsuk, S. S. Hamid, Amna S. Butt, Wasim Jafri, Akash Shukla, Vivek Saraswat, Soek Siam Tan, Ajit Sood, Vandana Midha, Omesh Goyal, Hasmik Ghazinyan, Anil Arora, Jinhua Hu, Manoj Sahu, P. N. Rao, Guan H. Lee, Seng G. Lim, Laurentius A. Lesmana, Cosmas Rinaldi Lesmana, Samir Shah, V. G. Mohan Prasad, Diana A. Payawal, Zaigham Abbas, A. Kadir Dokmeci, Jose D. Sollano, Gian Carpio, Ananta Shresta, G. K. Lau, Md. Fazal Karim, Gamal Shiha, Rino Gani, Kemal Fariz Kalista, Man-Fung Yuen, Seema Alam, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal, Viniyendra Pamecha, Ankur Jindal, V. Rajan, Vinod Arora, Osamu Yokosuka, Madunil A. Niriella, Hai Li, Xiaolong Qi, Atsushi Tanaka, Satoshi Mochida, Dominic Ray Chaudhuri, Ed Gane, Khin Maung Win, Wei Ting Chen, Mohd. Rela, Dharmesh Kapoor, Amit Rastogi, Pratibha Kale, Archana Rastogi, Chhagan Bihari Sharma, Meenu Bajpai, Virender Singh, Madhumita Premkumar, Sudhir Maharashi, A. Olithselvan, Cyriac Abby Philips, Anshu Srivastava, Surender K. Yachha, Zeeshan Ahmad Wani, B. R. Thapa, Anoop Saraya, Shalimar, Ashish Kumar, Manav Wadhawan, Subash Gupta, Kaushal Madan, Puja Sakhuja, Vivek Vij, Barjesh C. Sharma, Hitendra Garg, Vishal Garg, Chetan Kalal, Lovkesh Anand, Tanmay Vyas, Rajan P. Mathur, Guresh Kumar, Priyanka Jain, Samba Siva Rao Pasupuleti, Yogesh K. Chawla, Abhijit Chowdhury, Shahinul Alam, Do Seon Song, Jin Mo Yang, Eileen L. Yoon, APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.

Published in: Hepatology International | Issue 4/2019

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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.
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Metadata
Title
Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update
Authors
Shiv Kumar Sarin
Ashok Choudhury
Manoj K. Sharma
Rakhi Maiwall
Mamun Al Mahtab
Salimur Rahman
Sanjiv Saigal
Neeraj Saraf
A. S. Soin
Harshad Devarbhavi
Dong Joon Kim
R. K. Dhiman
Ajay Duseja
Sunil Taneja
C. E. Eapen
Ashish Goel
Q. Ning
Tao Chen
Ke Ma
Z. Duan
Chen Yu
Sombat Treeprasertsuk
S. S. Hamid
Amna S. Butt
Wasim Jafri
Akash Shukla
Vivek Saraswat
Soek Siam Tan
Ajit Sood
Vandana Midha
Omesh Goyal
Hasmik Ghazinyan
Anil Arora
Jinhua Hu
Manoj Sahu
P. N. Rao
Guan H. Lee
Seng G. Lim
Laurentius A. Lesmana
Cosmas Rinaldi Lesmana
Samir Shah
V. G. Mohan Prasad
Diana A. Payawal
Zaigham Abbas
A. Kadir Dokmeci
Jose D. Sollano
Gian Carpio
Ananta Shresta
G. K. Lau
Md. Fazal Karim
Gamal Shiha
Rino Gani
Kemal Fariz Kalista
Man-Fung Yuen
Seema Alam
Rajeev Khanna
Vikrant Sood
Bikrant Bihari Lal
Viniyendra Pamecha
Ankur Jindal
V. Rajan
Vinod Arora
Osamu Yokosuka
Madunil A. Niriella
Hai Li
Xiaolong Qi
Atsushi Tanaka
Satoshi Mochida
Dominic Ray Chaudhuri
Ed Gane
Khin Maung Win
Wei Ting Chen
Mohd. Rela
Dharmesh Kapoor
Amit Rastogi
Pratibha Kale
Archana Rastogi
Chhagan Bihari Sharma
Meenu Bajpai
Virender Singh
Madhumita Premkumar
Sudhir Maharashi
A. Olithselvan
Cyriac Abby Philips
Anshu Srivastava
Surender K. Yachha
Zeeshan Ahmad Wani
B. R. Thapa
Anoop Saraya
Shalimar
Ashish Kumar
Manav Wadhawan
Subash Gupta
Kaushal Madan
Puja Sakhuja
Vivek Vij
Barjesh C. Sharma
Hitendra Garg
Vishal Garg
Chetan Kalal
Lovkesh Anand
Tanmay Vyas
Rajan P. Mathur
Guresh Kumar
Priyanka Jain
Samba Siva Rao Pasupuleti
Yogesh K. Chawla
Abhijit Chowdhury
Shahinul Alam
Do Seon Song
Jin Mo Yang
Eileen L. Yoon
APASL ACLF Research Consortium (AARC) for APASL ACLF working Party.
Publication date
01-07-2019
Publisher
Springer India
Published in
Hepatology International / Issue 4/2019
Print ISSN: 1936-0533
Electronic ISSN: 1936-0541
DOI
https://doi.org/10.1007/s12072-019-09946-3

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