Abstract
Acute on chronic liver failure (ACLF) is a newly defined entity that complicates the course of relatively well patients with chronic liver disease. Depending upon its severity, ACLF is associated with 28-day mortality rates ranging from about 15% to over 80%. Treatment options for this condition are limited to supportive medical care and the role of transplantation is unknown. Louvet et al. report the results of a multicenter study assessing the outcomes of patients transplanted for severe ACLF (Grade 3) performed in France. Their remarkable study shows for the first time that the 1-year survival of patients with ACLF Grade 3 is like those with no ACLF (84% vs. 90%). The 1-year survival of ACLF Grade 3 patients who were not transplanted was only 8%. These data are extremely provocative and likely to change clinical practice, allowing these patients who are very sick to be considered as suitable candidates for transplantation.
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