From Critical Care to Transplant: Enhancing Outcomes in Acute-on-Chronic Liver Failure

Abstract Purpose of Review This review aims to provide a summary of intensive care management and liver transplant (LT) considerations for critically ill patients with cirrhosis and acute-on-chronic liver failure (ACLF). Recent Findings Survival rates for transplanted ACLF patients now approach those of non-ACLF LT recipients. However, candidate selection remains challenging, with high rates of waitlist removal and mortality. Summary Currently, LT is the only effective treatment for patients with ACLF, conferring significant survival benefits and increased resource utilization. High-grade ACLF, defined by the dynamic assessment of associated organ failures at days 3–7, is the most reliable prognostic indicator in ACLF. Liver-specific scores, like the Model for End-Stage Liver Disease, underestimate ACLF mortality, disadvantaging these patients on the waitlist. Improved ICU management of ACLF patients and early LT are associated with improved patient outcomes. Ongoing efforts to develop scoring systems and policies that improve access to LT for ACLF patients are underway.