Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia.

Journal: Hepatology International

Published: October 26, 2024

Abstract

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies.

Authors

Ashok Choudhury, Anand Kulkarni, Vinod Arora, A Soin, Abdul Dokmeci, Abhijeet Chowdhury, Abraham Koshy, Ajay Duseja, Ajay Kumar, Ajay Mishra, Ajay Patwa, Ajit Sood, Akash Roy, Akash Shukla, Albert Chan, Aleksander Krag, Amar Mukund, Ameet Mandot, Amit Goel, Amna Butt, Amrish Sahney, Ananta Shrestha, Andrés Cárdenas, Angelo Di Giorgio, Anil Arora, Anil Anand, Anil Dhawan, Ankur Jindal, Anoop Saraya, Anshu Srivastava, Anupam Kumar, Apichat Kaewdech, Apurva Pande, Archana Rastogi, Arun Valsan, Ashish Goel, Ashish Kumar, Ashwani Singal, Atsushi Tanaka, Audrey Coilly, Ayaskanta Singh, Babu Meena, Barath Jagadisan, Barjesh Sharma, Bikrant Lal, C Eapen, Cesar Yaghi, Chandan Kedarisetty, Chang Kim, Charles Panackel, Chen Yu, Chetan Kalal, Chhagan Bihari, Chien Huang, Chitranshu Vasishtha, Christian Jansen, Christian Strassburg, Chun Lin, Constantine Karvellas, Cosmas Rinaldi Lesmana, Cyriac Philips, Debbie Shawcross, Dharmesh Kapoor, Dhiraj Agrawal, Diana Payawal, Dibya Praharaj, Dinesh Jothimani, Do Song, Dong Kim, Dong-sik Kim, Duan Zhongping, Fazal Karim, Francois Durand, Gamal Shiha, Gennaro D'amico, George Lau, Girish Pati, Graciela Elia Narro, Guan-huei Lee, Gupse Adali, Guru Dhakal, Gyongyi Szabo, H Lin, Hai Li, Hari Nair, Harshad Devarbhavi, Harshvardhan Tevethia, Hasmik Ghazinian, Hemamala Ilango, Hong Yu, Irsan Hasan, J Fernandez, Jacob George, Jaideep Behari, James Fung, Jasmohan Bajaj, Jaya Benjamin, Jennifer Lai, Jidong Jia, Jin Hu, Jin Chen, Jin Hou, Jin Yang, Johannes Chang, Jonel Trebicka, Jörg Kalf, Jose Sollano, Joy Varghese, Juan Arab, Jun Li, K Reddy, Kaiser Raja, Kalpana Panda, Kamal Kajal, Karan Kumar, Kaushal Madan, Kemal Kalista, Kessarin Thanapirom, Khin Win, Ki Suk, Krishnadas Devadas, Laurentius Lesmana, Lubna Kamani, Madhumita Premkumar, Madunil Niriella, Mamun Al Mahtab, Man Yuen, Manal Sayed, Manasa Alla, Manav Wadhawan, Manoj Sharma, Manoj Sahu, Manya Prasad, Mark Muthiah, Martin Schulz, Meenu Bajpai, Mettu Reddy, Michael Praktiknjo, Ming Yu, Mithra Prasad, Mithun Sharma, Mohamed Elbasiony, Mohammed Eslam, Mohd Azam, Mohd Rela, Moreshwar Desai, Mukul Vij, Nadim Mahmud, Narendra Choudhary, Navin Marannan, Necati Ormeci, Neeraj Saraf, Nipun Verma, Nobuaki Nakayama, Norifumi Kawada, Oidov Baatarkhuu, Omesh Goyal, Osamu Yokosuka, P Rao, Paolo Angeli, Pathik Parikh, Patrick Kamath, Paul Thuluvath, Philipp Lingohr, Piyush Ranjan, Prashant Bhangui, Pravin Rathi, Puja Sakhuja, Puneet Puri, Qin Ning, R Dhiman, Rahul Kumar, Rajan Vijayaraghavan, Rajeev Khanna, Rakhi Maiwall, Ravi Mohanka, Richard Moreau, Rino Gani, Rohit Loomba, Rohit Mehtani, Ruveena Rajaram, S Hamid, Sachin Palnitkar, Sadhna Lal, Sagnik Biswas, Sakkarin Chirapongsathorn, Samagra Agarwal, Sanjeev Sachdeva, Sanjiv Saigal, Santhosh Kumar, Sargsyan Violeta, Satender Singh, Satoshi Mochida, Saurabh Mukewar, Seema Alam, Seng Lim, Shahinul Alam, Shalimar, Shantan Venishetty, Shikha Sundaram, Shiran Shetty, Shobna Bhatia, Shweta Singh, Shyam Kottilil, Simone Strasser, S Shasthry, Soe Maung, Soek Tan, Sombat Treeprasertsuk, Sonal Asthana, Steffen Manekeller, Subhash Gupta, Subrat Acharya, Sudhamshu K C, Sudhir Maharshi, Sumeet Asrani, Sunil Dadhich, Sunil Taneja, Suprabhat Giri, Surender Singh, Tao Chen, Tarana Gupta, Tatsuo Kanda, Tawesak Tanwandee, Teerha Piratvishuth, Ulrich Spengler, G Prasad, Vandana Midha, Venera Rakhmetova, Vicente Arroyo, Vikrant Sood, Vinay Br, Vincent Wong, Viniyendra Pamecha, Virendra Singh, Vishwa Dayal, Vivek Saraswat, Wray Kim, Wasim Jafri, Wenyi Gu, Wong Jun, Xiaolong Qi, Yogesh Chawla, Yoon Kim, Yu Shi, Zaigham Abbas, Guresh Kumar, Shuichiro Shiina, Lai Wei, Masao Omata, Shiv Sarin

Relevant Conditions

Liver Transplant, Liver Failure

Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia.

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