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Arch Hellen Med, 30(5), September-October 2013, 522-534


Acute on chronic liver failure

G. Kalpakou, S.P. Dourakis
Second Department of Medicine, National and Kapodistrian University of Athens, Medical School, "Hippokration" General Hospital, Athens, Greece

The term "acute on chronic liver failure" (ACLF) refers to a distinct clinical entity that occurs in patients with previous liver disease, especially cirrhosis of any etiology, who present acute, severe deterioration of their clinical condition due to the effects of a precipitating event. ACLF is characterized by very high short-term mortality due to multiorgan failure, but it is potentially reversible. The pathophysiology of ACLF is related to the immune dysfunction, intestinal bacterial translocation and circulatory dysfunction that consist a feature of chronic liver disease. The clinical manifestations may be derived from any organ, but mainly from the liver, brain and kidneys and the circulatory system. Infection is the leading cause of mortality. The prognosis depends on the severity of liver failure and the number of failing organs. The therapeutic approach is supportive, in order to gain time for the liver to recover or to be prepared for liver transplantation. Non-biological liver assisting devices have not been shown to provide any survival benefit, but they can be used as a bridge towards transplantation.

Key words: Artificial liver, Cirrhosis, Intestinal bacterial translocation, Liver failure, Liver transplantation.

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