Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025?
Acute-on-chronic liver failure (ACLF) is a critical condition that arises in the context of advanced liver disease, marked by rapid liver function deterioration and associated multi-organ failure. This syndrome is associated with a major short-term mortality risk, requiring aggressive and specialize...
Saved in:
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-08-01
|
| Series: | Transplant International |
| Subjects: | |
| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14752/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849684141116751872 |
|---|---|
| author | Sébastien L’Hermite Sébastien L’Hermite Valentin Coirier Florent Artru Florent Artru |
| author_facet | Sébastien L’Hermite Sébastien L’Hermite Valentin Coirier Florent Artru Florent Artru |
| author_sort | Sébastien L’Hermite |
| collection | DOAJ |
| description | Acute-on-chronic liver failure (ACLF) is a critical condition that arises in the context of advanced liver disease, marked by rapid liver function deterioration and associated multi-organ failure. This syndrome is associated with a major short-term mortality risk, requiring aggressive and specialized clinical care. Despite ongoing efforts, effective therapeutic options for ACLF are lacking, with liver transplantation (LT) considered the only life-saving intervention, yielding acceptable outcomes in carefully selected patients. However, the place of LT for ACLF remains a matter of debate, given the high prevalence of the syndrome, the sickness of liver transplant candidates, the persistent shortage of available liver grafts, and the increasing number of indications to LT. This review aims to provide a comprehensive analysis of the role of LT in ACLF, evaluating current evidence on patient selection, optimal timing for transplantation, and ongoing debates surrounding this practice, specifically the rationale for prioritizing graft allocation for this indication. Furthermore, we will explore global management strategies for ACLF, focusing on bridging patients to LT and improving survival outcomes. Through this review, we seek to enhance understanding of the evolving role of LT in ACLF and offer insights into future directions for clinical practice and research in this critical area. |
| format | Article |
| id | doaj-art-556798de0a3a4f0c96ae29b91ef38066 |
| institution | DOAJ |
| issn | 1432-2277 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Transplant International |
| spelling | doaj-art-556798de0a3a4f0c96ae29b91ef380662025-08-20T03:23:34ZengFrontiers Media S.A.Transplant International1432-22772025-08-013810.3389/ti.2025.1475214752Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025?Sébastien L’Hermite0Sébastien L’Hermite1Valentin Coirier2Florent Artru3Florent Artru4Service des maladies du foie, hôpital Pontchaillou, CHU Rennes, Rennes Liver Failure Group RELIEF, Rennes, FranceUniversité de Rennes et institut NuMeCan Inserm U1241, Rennes, FranceService de Médecine Intensive Réanimation, hôpital Pontchaillou, CHU Rennes, Rennes Liver Failure Group RELIEF, Rennes, FranceService des maladies du foie, hôpital Pontchaillou, CHU Rennes, Rennes Liver Failure Group RELIEF, Rennes, FranceUniversité de Rennes et institut NuMeCan Inserm U1241, Rennes, FranceAcute-on-chronic liver failure (ACLF) is a critical condition that arises in the context of advanced liver disease, marked by rapid liver function deterioration and associated multi-organ failure. This syndrome is associated with a major short-term mortality risk, requiring aggressive and specialized clinical care. Despite ongoing efforts, effective therapeutic options for ACLF are lacking, with liver transplantation (LT) considered the only life-saving intervention, yielding acceptable outcomes in carefully selected patients. However, the place of LT for ACLF remains a matter of debate, given the high prevalence of the syndrome, the sickness of liver transplant candidates, the persistent shortage of available liver grafts, and the increasing number of indications to LT. This review aims to provide a comprehensive analysis of the role of LT in ACLF, evaluating current evidence on patient selection, optimal timing for transplantation, and ongoing debates surrounding this practice, specifically the rationale for prioritizing graft allocation for this indication. Furthermore, we will explore global management strategies for ACLF, focusing on bridging patients to LT and improving survival outcomes. Through this review, we seek to enhance understanding of the evolving role of LT in ACLF and offer insights into future directions for clinical practice and research in this critical area.https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14752/fullcirrhosisacute-on-chronic liver failure (ACLF)liver transplantationliver transplantation windoworgan failure |
| spellingShingle | Sébastien L’Hermite Sébastien L’Hermite Valentin Coirier Florent Artru Florent Artru Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025? Transplant International cirrhosis acute-on-chronic liver failure (ACLF) liver transplantation liver transplantation window organ failure |
| title | Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025? |
| title_full | Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025? |
| title_fullStr | Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025? |
| title_full_unstemmed | Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025? |
| title_short | Liver Transplantation in the Context of Acute-On-Chronic Liver Failure (ACLF): Where Do We Stand in 2025? |
| title_sort | liver transplantation in the context of acute on chronic liver failure aclf where do we stand in 2025 |
| topic | cirrhosis acute-on-chronic liver failure (ACLF) liver transplantation liver transplantation window organ failure |
| url | https://www.frontierspartnerships.org/articles/10.3389/ti.2025.14752/full |
| work_keys_str_mv | AT sebastienlhermite livertransplantationinthecontextofacuteonchronicliverfailureaclfwheredowestandin2025 AT sebastienlhermite livertransplantationinthecontextofacuteonchronicliverfailureaclfwheredowestandin2025 AT valentincoirier livertransplantationinthecontextofacuteonchronicliverfailureaclfwheredowestandin2025 AT florentartru livertransplantationinthecontextofacuteonchronicliverfailureaclfwheredowestandin2025 AT florentartru livertransplantationinthecontextofacuteonchronicliverfailureaclfwheredowestandin2025 |