Universität zu Köln

Allhoff, Benedict ORCID: 0009-0008-0966-8011, Neumann-Haefelin, Christoph ORCID: 0000-0001-7351-1387 and Kasper, Philipp ORCID: 0000-0002-6218-2239 (2025). Acute-on-Chronic Liver Failure—Current Management and Future Perspectives. Biomedicines, 13 (9). MDPI. ISSN 2227-9059

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Abstract

[Artikel-Nr. 2193] Acute-on-chronic liver failure (ACLF) is a distinct clinical syndrome characterized by an acute decompensation of chronic liver disease in association with extrahepatic organ failure(s) and a high short-term mortality. Despite its increasing clinical relevance, there is no internationally standardized definition of ACLF to date. This review provides a comprehensive overview of current ACLF definitions, underlying pathogenic mechanisms, frequent precipitating events, and current treatment strategies. While liver transplantation remains the only curative treatment option, its role in the setting of ACLF is controversially debated, and patient selection remains complex due to high perioperative risk. Thus, the review article describes the current role of liver transplantation in patients with ACLF and describes novel prognostic scoring systems (e.g., TAM core, SALT-M model) that may be helpful in selecting suitable transplant candidates. Further emerging treatment options for ACLF include extracorporeal liver support systems, therapeutic plasma exchange, and immune-modulating approaches targeting toll-like receptor signaling that offer promising adjunctive strategies, though clinical evidence remains limited. Given the high burden and complexity of ACLF, harmonized definitions and evidence-based therapeutic frameworks are urgently needed to improve patient care and optimize transplant prioritization.

Item Type:	Article
Creators:	Creators Email ORCID ORCID Put Code Allhoff, Benedict UNSPECIFIED https://orcid.org/0009-0008-0966-8011 UNSPECIFIED Neumann-Haefelin, Christoph UNSPECIFIED https://orcid.org/0000-0001-7351-1387 UNSPECIFIED Kasper, Philipp UNSPECIFIED https://orcid.org/0000-0002-6218-2239 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-800610
Identification Number:	10.3390/biomedicines13092193
Journal or Publication Title:	Biomedicines
Volume:	13
Number:	9
Number of Pages:	19
Date:	8 September 2025
Publisher:	MDPI
ISSN:	2227-9059
Language:	English
Faculty:	Faculty of Medicine
Divisions:	Faculty of Medicine > Innere Medizin > Klinik für Gastroenterologie und Hepatologie
Subjects:	Medical sciences Medicine
Uncontrolled Keywords:	Keywords Language liver cirrhosis ; complications ; acute decompensation ; liver failure ; acute-on-chronic liver failure English
['eprint_fieldname_oa_funders' not defined]:	Publikationsfonds UzK
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/80061