Acute-On-Chronic Liver Failure: Current Concepts On Definition, Pathogenesis, Clinical Manifestations And Potential Therapeutic Interventions

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Acute-on-chronic liver failure:
current concepts on definition,
pathogenesis, clinical
manifestations and potential
therapeutic interventions
Expert Rev. Gastroenterol. Hepatol. 5 (4), 523–537 (2011)

Wim Laleman†1*, Len
Verbeke1*, Philippe
Meersseman2, Joost
Wauters2, Jos van Pelt1,
David Cassiman1,Alexander Wilmer2,
Chris Verslype1 and
Frederik Nevens1
Department of Liver and
Biliopancreatic disorders, University
Hospital Gasthuisberg, KU Leuven,
B -3000 Leuven, Belgium
2
Medical Intensive Care, University
Hospital Gasthuisberg, KU Leuven,
Leuven, Belgium
†
Author for correspondence:
Tel.: +32 163 442 99
Fax: +32 163 443 87
wim.laleman@uzleuven.be

In recent years,acute-on-chronic liver failure has been recognized as a specific clinical form of
liver failure associated with cirrhosis. The syndrome refers to an acute deterioration of liver
function and subsequently of other end organs over a period of weeks following a precipitating
event in a patient with previously well- or reasonably well-compensated cirrhosis. These
precipitatingevents include either an indirect (e.g., variceal hemorrhage, sepsis) or a
direct (e.g., drug-induced) hepatotoxic factor. The short-term mortality for this condition is more
than 50%. At present, considerable efforts are ongoing to better characterize the syndrome,
to gain further insight into its pathophysiology and to optimize therapy. This article aims tohighlight the current concepts of these various aspects.

1

Wim Laleman and Len Verbeke
contributed equally and share first
authorship
*

Keywords : cirrhosis • liver failure • liver support • multiorgan failure • portal hypertension

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Learning objectives
Upon completion of this activity, participants will be able to:
• Describe the definition and clinical characteristics of ACLF and its distinction from end-stage liver
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• Describe the pathophysiology and clinical course of ACLF
• Describe therapeutic interventions that may be useful in ACLFwww.expert-reviews.com

10.1586/EGH.11.47

© 2011 Expert Reviews Ltd

ISSN 1747-4124

523

Review

Laleman, Verbeke, Meersseman et al.

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Financial & competing interests disclosure

Editor
Elisa Manzotti
Editorial Director, Future Science Group, London, UK.
Disclosure: Elisa Manzotti has disclosed no relevant financial relationships.
CME Author
Laurie Barclay, MD
Freelancewriter and reviewer, Medscape, LLC.
Disclosure: Laurie Barclay has disclosed no relevant financial relationships.
Author and Credentials
Wim Laleman
Department of Liver and Biliopancreatic Disorders, University Hospital Gasthuisberg, KU Leuven, Leuven, Belgium.
Disclosure: Wim Laleman has disclosed the following relevant financial relationships: Serves as a senior clinical investigator for...