Acute liver failure (ALF) and acute-on-chronic liver (ACLF) are distinct phenotypes of liver failure and, thus, need to be compared and contrasted for appropriate management. There has been a significant improvement in the outcomes of these patients undergoing liver transplantation (LT). Survival post-LT for ALF and ACLF ranges between 90% and 95% and 80% and 90% at 1 year, futility criteria have been described in both ALF and ACLF where organ failures define survival. Plasma exchange and continuous renal replacement therapy may serve as bridging therapies. Identifying the futility of LT is as necessary as the utility of LT in patients with ALF and ACLF. The role of regenerative therapies such as granulocyte colony-stimulating factors in ACLF and hepatocyte and xenotransplantation in both conditions remains uncertain. Measures to increase the donor pool through increasing deceased donor transplants in Asian countries, living donations in Western countries, auxiliary liver transplants, and ABO-incompatible liver transplants are necessary to improve the survival of these patients. In this review, we discuss the similarities and differences in clinical characteristics and the timing and outcomes of LT for ALF and ACLF, briefly highlighting the role of bridging therapies and providing an overview of recent advances in the management of ALF and ACLF.

中文翻译：

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急性肝衰竭和慢加急性肝衰竭的肝移植


急性肝衰竭 （ALF） 和慢加急性肝 （ACLF） 是肝衰竭的不同表型，因此需要进行比较和对比以进行适当的管理。这些接受肝移植 （LT） 的患者的结局有显著改善。ALF 和 ACLF 的 LT 后生存率在 90% 到 95% 之间，1 年时在 80% 和 90% 之间，ALF 和 ACLF 都描述了无效标准，其中器官衰竭定义了生存。血浆置换和连续性肾脏替代治疗可作为过渡疗法。识别 LT 的无效性与 LT 在 ALF 和 ACLF 患者中的效用一样必要。再生疗法（例如粒细胞集落刺激因子）在 ACLF 和肝细胞和异种移植中的作用在这两种情况下仍不确定。通过增加亚洲国家的已故供体移植、西方国家的活体捐献、辅助肝移植和 ABO 血型不合的肝移植来增加供体库的措施对于提高这些患者的生存率是必要的。在本综述中，我们讨论了 ALF 和 ACLF 临床特征的异同以及 LT 的时间和结局，简要强调了桥接疗法的作用，并概述了 ALF 和 ACLF 管理的最新进展。