Transplantace jater pro ACLF

Abstract

Summary: Acute-on-chronic liver failure (ACLF) occurs in about one third of patients hospitalized for decmopensation of liver cirrhosis. It is defined as a failure of at least one organ, mostly the kidneys and/or liver, and very high short-term mortality. The most common trigger, precipitating event, is an infection or alcohol abuse. ACLF is caused by an excessive inflammatory reaction to the presence od microbial or sterile molecular structures in the blood circulation, and a disturbed immune response. ACLF is a very dynamic process and the condition must be reevaluated continuously according to the available scoring systems, early contact the transplant center and consider the possibility of this only curative treatment. We should be aware of renal function, nutrition, antimicrobial treatment and in patients with alcoholic hepatitis, it is necessary to consider the administration of corticosteroids. Liver transplantation for ACLF has somewhat worse one-year survival compared to other transplant groups, but long-term survival is comparable. Key words: ACLF – precipitating event – alcohol hepatitis – infection – liver transplantation