# Acute-on-chronic liver failure: a retrospective review of cases at a transplantation center in Brazil

## TL;DR

This study examines acute-on-chronic liver failure in Brazil, finding liver transplantation significantly improves survival, especially for severe cases.

## Contribution

The study provides real-world data on ACLF outcomes and highlights liver transplantation's effectiveness in a Brazilian LT center.

## Key findings

- 35% 28-day mortality rate for ACLF patients, increasing with severity.
- Liver transplantation resulted in 100% 28-day survival for transplanted patients.
- Transplantation significantly improved survival in ACLF-3 cases compared to no transplant.

## Abstract

Acute-on-chronic liver failure (ACLF) is a leading cause of death in cirrhotic patients. This study aims to describe the outcomes of in-patients with ACLF at a liver transplantation (LT) center in Brazil.

Retrospective study analyzing patient data from 2017 to 2022. Re-transplant cases and patients without previous chronic liver disease were excluded. The ACLF diagnosis was based on the European Association for the Study of the Liver-Chronic Liver Failure criteria and assessments repeated on days 3 and 7 after the initial diagnosis.

Among 381 patients, 10.49% (n = 40) were diagnosed with ACLF. Bacterial infection was the most common precipitating factor (45%). Kidney failure occurred in 65% of the cases. The 28-day mortality rate was 35% and varied according to ACLF severity at diagnosis, from single organ failure (ACLF-1) at 22% to three organ failures (ACLF-3) at 60%. Eighteen patients (45%) were transplanted with a 100% 28-day survival rate. For ACLF-3 cases at diagnosis (n = 15), the 28-day and 1-year survival rates with a transplant (n = 4) were 100% and 80%, respectively, and without transplant (n = 11), 10 and 0%, respectively.

ACLF was associated with high mortality rates. LT was an effective therapeutic option, particularly for ACLF-3 cases.