Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia
6
Issued Date
2025-02-01
Resource Type
eISSN
19360541
Scopus ID
2-s2.0-85219757138
Pubmed ID
39961976
Journal Title
Hepatology international
Volume
19
Issue
1
Start Page
1
End Page
69
Rights Holder(s)
SCOPUS
Bibliographic Citation
Hepatology international Vol.19 No.1 (2025) , 1-69
Suggested Citation
Choudhury A., Kulkarni A.V., Arora V., Soin A.S., Dokmeci A.K., Chowdhury A., Koshy A., Duseja A., Kumar A., Mishra A.K., Patwa A.K., Sood A., Roy A., Shukla A., Chan A., Krag A., Mukund A., Mandot A., Goel A., Butt A.S., Sahney A., Shrestha A., Cárdenas A., Di Giorgio A., Arora A., Anand A.C., Dhawan A., Jindal A., Saraya A., Srivastava A., Kumar A., Kaewdech A., Pande A., Rastogi A., Valsan A., Goel A., Kumar A., Singal A.K., Tanaka A., Coilly A., Singh A., Meena B.L., Jagadisan B., Sharma B.C., Lal B.B., Eapen C.E., Yaghi C., Kedarisetty C.K., Kim C.W., Panackel C., Yu C., Kalal C.R., Bihari C., Huang C.H., Vasishtha C., Jansen C., Strassburg C., Lin C.Y., Karvellas C.J., Lesmana C.R.A., Philips C.A., Shawcross D., Kapoor D., Agrawal D., Payawal D.A., Praharaj D.L., Jothimani D., Song D.S., Kim D.J., Kim D.S., Zhongping D., Karim F., Durand F., Shiha G.E., D'Amico G., Lau G.K., Pati G.K., Narro G.E.C., Lee G.H., Adali G., Dhakal G.P., Szabo G., Lin H.C., Li H., Nair H.K., Devarbhavi H., Tevethia H., Ghazinian H., Ilango H., Yu H.L., Hasan I., Fernandez J., George J., Behari J., Fung J., Bajaj J., Benjamin J., Lai J.C., Jia J., Hu J.H. Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia. Hepatology international Vol.19 No.1 (2025) , 1-69. 69. doi:10.1007/s12072-024-10773-4 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/106651
Title
Acute-on-chronic liver failure (ACLF): the 'Kyoto Consensus'-steps from Asia
Author(s)
Choudhury A.
Kulkarni A.V.
Arora V.
Soin A.S.
Dokmeci A.K.
Chowdhury A.
Koshy A.
Duseja A.
Kumar A.
Mishra A.K.
Patwa A.K.
Sood A.
Roy A.
Shukla A.
Chan A.
Krag A.
Mukund A.
Mandot A.
Goel A.
Butt A.S.
Sahney A.
Shrestha A.
Cárdenas A.
Di Giorgio A.
Arora A.
Anand A.C.
Dhawan A.
Jindal A.
Saraya A.
Srivastava A.
Kumar A.
Kaewdech A.
Pande A.
Rastogi A.
Valsan A.
Goel A.
Kumar A.
Singal A.K.
Tanaka A.
Coilly A.
Singh A.
Meena B.L.
Jagadisan B.
Sharma B.C.
Lal B.B.
Eapen C.E.
Yaghi C.
Kedarisetty C.K.
Kim C.W.
Panackel C.
Yu C.
Kalal C.R.
Bihari C.
Huang C.H.
Vasishtha C.
Jansen C.
Strassburg C.
Lin C.Y.
Karvellas C.J.
Lesmana C.R.A.
Philips C.A.
Shawcross D.
Kapoor D.
Agrawal D.
Payawal D.A.
Praharaj D.L.
Jothimani D.
Song D.S.
Kim D.J.
Kim D.S.
Zhongping D.
Karim F.
Durand F.
Shiha G.E.
D'Amico G.
Lau G.K.
Pati G.K.
Narro G.E.C.
Lee G.H.
Adali G.
Dhakal G.P.
Szabo G.
Lin H.C.
Li H.
Nair H.K.
Devarbhavi H.
Tevethia H.
Ghazinian H.
Ilango H.
Yu H.L.
Hasan I.
Fernandez J.
George J.
Behari J.
Fung J.
Bajaj J.
Benjamin J.
Lai J.C.
Jia J.
Hu J.H.
Kulkarni A.V.
Arora V.
Soin A.S.
Dokmeci A.K.
Chowdhury A.
Koshy A.
Duseja A.
Kumar A.
Mishra A.K.
Patwa A.K.
Sood A.
Roy A.
Shukla A.
Chan A.
Krag A.
Mukund A.
Mandot A.
Goel A.
Butt A.S.
Sahney A.
Shrestha A.
Cárdenas A.
Di Giorgio A.
Arora A.
Anand A.C.
Dhawan A.
Jindal A.
Saraya A.
Srivastava A.
Kumar A.
Kaewdech A.
Pande A.
Rastogi A.
Valsan A.
Goel A.
Kumar A.
Singal A.K.
Tanaka A.
Coilly A.
Singh A.
Meena B.L.
Jagadisan B.
Sharma B.C.
Lal B.B.
Eapen C.E.
Yaghi C.
Kedarisetty C.K.
Kim C.W.
Panackel C.
Yu C.
Kalal C.R.
Bihari C.
Huang C.H.
Vasishtha C.
Jansen C.
Strassburg C.
Lin C.Y.
Karvellas C.J.
Lesmana C.R.A.
Philips C.A.
Shawcross D.
Kapoor D.
Agrawal D.
Payawal D.A.
Praharaj D.L.
Jothimani D.
Song D.S.
Kim D.J.
Kim D.S.
Zhongping D.
Karim F.
Durand F.
Shiha G.E.
D'Amico G.
Lau G.K.
Pati G.K.
Narro G.E.C.
Lee G.H.
Adali G.
Dhakal G.P.
Szabo G.
Lin H.C.
Li H.
Nair H.K.
Devarbhavi H.
Tevethia H.
Ghazinian H.
Ilango H.
Yu H.L.
Hasan I.
Fernandez J.
George J.
Behari J.
Fung J.
Bajaj J.
Benjamin J.
Lai J.C.
Jia J.
Hu J.H.
Author's Affiliation
VPS Lakeshore
Nanavati Max Super Speciality Hospital
Max Super Speciality Hospital, Delhi
Apollo Multispeciality Hospitals Kolkata
Kalinga Institute of Medical Sciences
Jigme Dorji Wangchuck National Referral Hospital
University of Health Sciences
Papa Giovanni XXIII Hospital
Centre de Recherche sur l’Inflammation (CRI)
Institute of Liver and Biliary Sciences
Université Paris-Saclay
Medanta - The Medicity
Fortis Healthcare Ltd.
Renji Hospital
Siksha O Anusandhan (Deemed to be University)
Madras Institute of Orthopaedics and Traumatology Hospitals
VHS Medical Centre India
Sir H. N. Reliance Foundation Hospital and Research Centre
Seth GS Medical College and KEM Hospital
General Hospital of People's Liberation Army
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Hôtel-Dieu de France Hospital
The Aga Khan University
Institute of Post Graduate Medical Education & Research
Fundacion Clinica Medica Sur
Chang Gung Memorial Hospital
National University Hospital
University of Alberta
Mitford Hospital
Teikyo University School of Medicine
Korea University College of Medicine
Capital Medical University
The University of Sydney
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Sir Ganga Ram Hospital
University of California, San Francisco
St. John's National Academy Of Health Sciences India
King's College Hospital
King George's Medical University
Syddansk Universitet
University of Louisville School of Medicine
Hallym University
Asian Institute of Gastroenterology India
Taipei Veterans General Hospital
Ankara Üniversitesi
Mansoura University
University of Pittsburgh Medical Center
Institut d'Investigacions Biomèdiques August Pi i Sunyer - IDIBAPS
Instituto Nacional de la Nutrición Salvador Zubiran
Amrita Institute of Medical Sciences India
Dayanand Medical College & Hospital
Universität Bonn
The University of Hong Kong
The Catholic University of Korea
Harvard Medical School
Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
Virginia Commonwealth University
Universitat de Barcelona
Christian Medical College, Vellore
Postgraduate Institute of Medical Education and Research, Chandigarh
Prince-of Song-Kla University
Rajagari Hospital
Fatima Medical University Hospital
Kinder Multispeciality Hospital
Gleneagles Global Hospitals
Alka Hospital
Yerevan Medical Scientific Center
PACE Hospitals
Global Hospital
Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello
Santiago de Chile
Medistra Hospital
SAR
Nanavati Max Super Speciality Hospital
Max Super Speciality Hospital, Delhi
Apollo Multispeciality Hospitals Kolkata
Kalinga Institute of Medical Sciences
Jigme Dorji Wangchuck National Referral Hospital
University of Health Sciences
Papa Giovanni XXIII Hospital
Centre de Recherche sur l’Inflammation (CRI)
Institute of Liver and Biliary Sciences
Université Paris-Saclay
Medanta - The Medicity
Fortis Healthcare Ltd.
Renji Hospital
Siksha O Anusandhan (Deemed to be University)
Madras Institute of Orthopaedics and Traumatology Hospitals
VHS Medical Centre India
Sir H. N. Reliance Foundation Hospital and Research Centre
Seth GS Medical College and KEM Hospital
General Hospital of People's Liberation Army
Universitas Indonesia, RSUPN Dr. Cipto Mangunkusumo
Hôtel-Dieu de France Hospital
The Aga Khan University
Institute of Post Graduate Medical Education & Research
Fundacion Clinica Medica Sur
Chang Gung Memorial Hospital
National University Hospital
University of Alberta
Mitford Hospital
Teikyo University School of Medicine
Korea University College of Medicine
Capital Medical University
The University of Sydney
Sanjay Gandhi Postgraduate Institute of Medical Sciences
Sir Ganga Ram Hospital
University of California, San Francisco
St. John's National Academy Of Health Sciences India
King's College Hospital
King George's Medical University
Syddansk Universitet
University of Louisville School of Medicine
Hallym University
Asian Institute of Gastroenterology India
Taipei Veterans General Hospital
Ankara Üniversitesi
Mansoura University
University of Pittsburgh Medical Center
Institut d'Investigacions Biomèdiques August Pi i Sunyer - IDIBAPS
Instituto Nacional de la Nutrición Salvador Zubiran
Amrita Institute of Medical Sciences India
Dayanand Medical College & Hospital
Universität Bonn
The University of Hong Kong
The Catholic University of Korea
Harvard Medical School
Govind Ballabh Pant Institute of Postgraduate Medical Education and Research
Virginia Commonwealth University
Universitat de Barcelona
Christian Medical College, Vellore
Postgraduate Institute of Medical Education and Research, Chandigarh
Prince-of Song-Kla University
Rajagari Hospital
Fatima Medical University Hospital
Kinder Multispeciality Hospital
Gleneagles Global Hospitals
Alka Hospital
Yerevan Medical Scientific Center
PACE Hospitals
Global Hospital
Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello
Santiago de Chile
Medistra Hospital
SAR
Corresponding Author(s)
Other Contributor(s)
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.