Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Hepatology International, Sep 2014

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, “APASL ACLF Research Consortium (AARC),” was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here.

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Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Shiv Kumar Sarin 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Chandan Kumar Kedarisetty 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Zaigham Abbas 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Deepak Amarapurkar 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Chhagan Bihari 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Albert C. Chan 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Yogesh Kumar Chawla 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 A. Kadir Dokmeci 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Hitendra Garg 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Hasmik Ghazinyan 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Saeed Hamid 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Dong Joon Kim 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Piyawat Komolmit 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Suman Lata 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Guan Huei Lee 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Laurentius A. Lesmana 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Mamun Mahtab 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Rakhi Maiwall 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Richard Moreau 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Qin Ning 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Viniyendra Pamecha 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Diana Alcantara Payawal 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Archana Rastogi 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Salimur Rahman 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Mohamed Rela 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Anoop Saraya 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Didier Samuel 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Vivek Saraswat 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Samir Shah 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Gamal Shiha 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Brajesh Chander Sharma 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Manoj Kumar Sharma 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Kapil Sharma 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Amna Subhan Butt 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Soek Siam Tan 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Chitranshu Vashishtha 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Zeeshan Ahmed Wani 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Man-Fung Yuen 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 Osamu Yokosuka 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 the APASL ACLF Working Party 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 0 D. Amarapurkar Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research , Mumbai, India 1 Z. Abbas Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation , Karachi, Pakistan 2 S. K. Sarin (&) C. K. Kedarisetty H. Garg R. Maiwall M. K. Sharma K. Sharma C. Vashishtha Z. A. Wani Department of Hepatology, Institute of Liver and Biliary Sciences , New Delhi 110070, India 3 D. J. Kim Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital , Chuncheon, Gangwon-Do, Republic of Korea 4 S. Hamid A. S. Butt Department of Medicine, Aga Khan University Hospital , Karachi, Pakistan 5 H. Ghazinyan Department of Hepatology, Nork Clinical Hospital of Infectious Diseases , Yerevan, Armenia 6 A. K. Dokmeci Department of Gastroenterology, Ankara University School of Medicine , Ankara, Turkey 7 Y. K. Chawla Department of Hepatology, Post Graduate Institute of Medical Education and Research , Chandigarh, India 8 A. C. Chan Division of Hepatobiliary and Pancreatic Surgery , and Liver Transplantation, Department of Surgery, The University of Hong Kong , Hong Kong, China 9 C. Bihari A. Rastogi Department of Pathology, Institute of Liver and Biliary Sciences , New Delhi 110070, India 10 G. H. Lee Department of Gastroenterology and Hepatology, National University Health System , Singapore, Singapore 11 S. Lata Department of Nephrology, Institute of Liver and Biliary Sciences , New Delhi 110070, India 12 P. Komolmit Division of Gastroenterology and Hepatology, Department of Medicine, Chulalongkorn University , Bangkok, Thailand 13 D. A. Payawal Department of Hepatology, Cardinal Santos Medical Center , Manila, Philippines 14 V. Pamecha Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences , New Delhi 110070, India 15 Q. Ning Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology , Wuhan, China 16 R. Moreau Departement Hospitalo-Universitaire (DHU) UNITY, Service d'Hepatologie , Hopital Beaujon, APHP, Clichy, France 17 R. Moreau Inserm, U1149, Centre de recherche sur l'Inflammation (CRI) , Paris, France 18 M. Mahtab S. Rahman Department of Hepatology, Bangabandhu Sheikh Mujib Medical University , Dhaka, Bangladesh 19 L. A. Lesmana Division of Hepatology, University of Indonesia , Jakarta, Indonesia 20 D. Samuel INSERM, Centre Hepatobiliarie , Hopital Paul Brousse, Villejuif, France 21 A. Saraya Department of Gastroenterology, All India Institute of Medical Sciences , New Delhi, India 22 M. Rela Institute of Liver Diseases and Transplantation, Global Health City , Chennai, India 23 O. Yokosuka Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University , Chiba, Japan 24 M.-F. Yuen Department of Medicine, The University of Hong Kong , Hong Kong, China 25 S. S. Tan Department of Gastroenterology and Hepatology, Selayang Hospital , Kepong, Malaysia 26 B. C. Sharma Department of Gastroenterology, GB Pant Hospital , New Delhi, India 27 G. Shiha Department of Internal Medicine, Egyptian Liver Research Institute (...truncated)


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Shiv Kumar Sarin, Chandan Kumar Kedarisetty, Zaigham Abbas, Deepak Amarapurkar, Chhagan Bihari, Albert C. Chan, Yogesh Kumar Chawla, A. Kadir Dokmeci, Hitendra Garg, Hasmik Ghazinyan, Saeed Hamid, Dong Joon Kim, Piyawat Komolmit, Suman Lata, Guan Huei Lee, Laurentius A. Lesmana, Mamun Mahtab, Rakhi Maiwall, Richard Moreau, Qin Ning, Viniyendra Pamecha, Diana Alcantara Payawal, Archana Rastogi, Salimur Rahman, Mohamed Rela, Anoop Saraya, Didier Samuel, Vivek Saraswat, Samir Shah, Gamal Shiha, Brajesh Chander Sharma, Manoj Kumar Sharma, Kapil Sharma, Amna Subhan Butt, Soek Siam Tan, Chitranshu Vashishtha, Zeeshan Ahmed Wani, Man-Fung Yuen, Osamu Yokosuka, the APASL ACLF Working Party. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014, Hepatology International, 2014, pp. 453-471, Volume 8, Issue 4, DOI: 10.1007/s12072-014-9580-2