Post-liver transplantation outcomes in acute-on-chronic liver failure: Impact of alcohol as a precipitant and etiology of chronic liver disease.

Background: Acute-on-chronic liver failure (ACLF) has been associated with excellent post- liver transplant (LT) outcomes at one year, however the impact of alcohol as ACLF precipitant, specifically alcohol-associated hepatitis (AH), and as etiology of chronic liver disease (CLD) remains uncertain. This study aimed to assess the effect of alcohol as ACLF precipitant and CLD etiology (alcohol-associated liver disease (ALD) vs. non-ALD) on post-transplant outcomes.

What's new in the critical care management of acute liver failure: a focus on global accessibility.

Introduction: Acute liver failure (ALF) is a rare syndrome characterized by acute severe liver dysfunction and hepatic encephalopathy. The etiology of ALF varies according to age and geographical distribution and hence management depends on the etiology and clinical condition.

Areas Covered: While high-income-countries (HIC) most often see acetaminophen (APAP) and drug-induced liver injury (DILI) as causes of ALF, low-middle-income countries (LMIC) face a higher burden of viral hepatitis (particularly hepatitis A and E virus) and herbal/traditional/toxin medicine-related ALF transplant-free survival from ALF continues to improve with corresponding reduced rates of intracranial hypertension and cerebral edema particularly in APAP-ALF.

Risk Evaluation and Recipient Selection in Adult Liver Transplantation: A Mixed-Methods Survey.

Background: Liver transplant (LT) is the definitive treatment for end-stage liver disease. Limited resources and important post-operative implications for recipients compel judicious risk stratification and patient selection. However, little is known about the factors influencing physicians' assessment regarding patient selection for LT and risk evaluation.

Risk factors for in-hospital postoperative complications and 6-month graft survival after liver transplantation: A multicenter cohort study.

Liver transplantation (LT) is a high-risk surgery requiring costly hospital resources. Robust multicenter data on the incidence of postoperative complications and their risk factors remain very limited. The objectives of this study were to describe the incidence and variability of postoperative complications in adult LT recipients and identify their determinants.

Hepatitis B Virus Variants and Cytokine Patterns in Acute Liver Failure and Transplant-Free Survival.

Background & Aims: Only 25% of hepatitis B-related acute liver failure (HBV-ALF) patients survive without liver transplantation (transplant-free survival, TFS). There is limited study of immunological and virological profiles in these patients. We analysed the association between hepatitis B viremia and cytokine patterns on TFS of HBV-ALF patients.

Stakeholder perspectives on the reduction of opioid exposure in ICU: A modified Delphi survey.

Purpose: The global opioid epidemic highlights the need to re-evaluate pain management strategies and find alternatives to minimize opioid exposure. Opioids are primary analgesics and sedatives in intensive care units (ICUs) but may have negative consequences for patients and families. This study aimed to identify key patient-important outcomes related to opioid reduction and the use of analgesic adjuncts (e.

The Diagnosis and Management of Hepatorenal Syndrome: A Comprehensive Update for the Intensivist.

Intensivists are being increasingly tasked with caring for critically ill patients with cirrhosis (ie, acute-on-chronic liver failure), many of whom develop acute kidney injury (AKI). Among the most morbid and complex causes of AKI in patients with cirrhosis is hepatorenal syndrome (HRS-AKI). Though HRS-AKI accounts for a fraction of AKI cases in the setting of cirrhosis, recent data suggest that effective pharmacologic treatment of HRS-AKI requires rapid diagnosis to allow for prompt intervention.

Therapeutic Plasma Exchange in Patients With Acute-On-Chronic Liver Failure Improves Survival-An Updated Meta-Analysis.

Background And Aim: Acute-on-chronic liver failure (ACLF) is a syndrome that develops after an acute insult and is associated with organ failures and high short-term mortality. Plasma exchange (PLEX) is an emerging modality for treating ACLF patients. We aimed to evaluate the efficacy of PLEX in treating ACLF.

Serum proteomics of adults with acute liver failure provides mechanistic insights and attractive prognostic biomarkers.

Background & Aims: Acute liver failure (ALF) is defined as rapid onset coagulopathy and encephalopathy in patients without a prior history of liver disease. We performed untargeted and targeted serum proteomics to delineate processes occurring in adult patients with ALF and to identify potential biomarkers.

Methods: Sera of 319 adult patients with ALF (∼50% acetaminophen [APAP]-related cases) were randomly selected from admission samples of the multicenter USA Acute Liver Failure Study Group consortium and subdivided into discovery/validation cohorts.

Brain CT Scan Diagnostic and Prognostic Value in Patients With Acute Liver Failure and Cerebral Edema: A Multicenter Cohort Study.

Objective: Patients with acute liver failure (ALF) may develop cerebral edema. We aimed to study the CT scan diagnostic and prognostic value among patients with ALF and cerebral edema.

Design: International multicenter retrospective cohort.

Failure to rescue in acute liver failure: A multicenter cohort study.

The concept of failure to rescue has been used to measure the quality of care for complications developed following surgery. The concept of failure to rescue has been poorly studied in patients with primary medical diseases, such as sepsis or acute liver failure (ALF). We performed a retrospective multicenter cohort study including consecutive patients with ALF within the United States ALF Study Group (USALFSG) prospective registry from 2010-2016.

Determining safe washout period for immune checkpoint inhibitors prior to liver transplantation: An international retrospective cohort study.

Background And Aims: Immune checkpoint inhibitors (ICIs) are increasingly used in patients with advanced HCC patients awaiting liver transplantation (LT). However, concerns about the risk of posttransplant rejection persist.

Approach And Results: We conducted an international retrospective cohort study including 119 HCC patients who received ICIs prior to LT.

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

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.

Protective effects of cyclosporine and its analog NIM-811 in a murine model of hepatic ischemia-reperfusion injury.

Background And Aim: The liver is susceptible to ischemia-reperfusion injury (IRI) during hepatic surgery, when the vessels are compressed to control bleeding, or liver transplantation, when there is an obligate period of ischemia. The hallmark of IRI comprises mitochondrial dysfunction, which generates reactive oxygen species, and cell death through necrosis or apoptosis. Cyclosporine (CsA), which is a well-known immunosuppressive agent that inhibits calcineurin, has the additional effect of inhibiting the mitochondrial permeability transition pore (mPTP), thereby, preventing mitochondrial swelling and injury.

Adjunctive Midodrine Therapy for Vasopressor-Dependent Shock in the ICU: A Systematic Review and Meta-Analysis.

Objectives: To summarize the efficacy of midodrine as an adjunctive therapy in critically ill patients. Safety of midodrine was assessed as a secondary outcome.

Data Sources: We performed a systematic review and meta-analysis using a peer-reviewed search strategy combining the themes of vasopressor-dependent shock, critical care, and midodrine and including MEDLINE, Ovid Embase, CINAHL, and Cochrane library databases until September 14, 2023.

Outcomes of patients with acute liver failure not listed for liver transplantation: A cohort analysis.

Background: Acute liver failure (ALF) is a rare condition leading to morbidity and mortality. Liver transplantation (LT) is often required, but patients are not always listed for LT. There is a lack of data regarding outcomes in these patients.

Long-Term Follow-Up of Kidney Function after Acute Liver Failure or Acute Liver Injury: A Cohort Study.

Introduction: Acute liver failure (ALF) is a rare disease with high mortality. Acute kidney injury (AKI) following ALF is frequent. We assessed AKI impact on long-term kidney function among ALF survivors.