Mistakes in ... Booklet 2020 - 17

ueg education

a patient who has no pre-existing chronic
liver disease.8 ALF is characterized by the
development of both coagulopathy (INR >1.5)
and hepatic encephalopathy. The condition of
patients who develop coagulopathy, but not
hepatic encephalopathy, is defined as acute liver
injury (ALI).
The clinical course of ALF usually starts with a
severe ALI. The ALI is characterized by a 2-3-fold
elevation of transaminase levels, associated
with impaired liver function (jaundice and
coagulopathy), in a patient with no prior
evidence of liver disease. Considering
jaundice as the first sign, 'hyperacute liver f
ailure' describes patients who develop hepatic
encephalopathy within 7 days, 'acute liver
failure' describes patients who develop hepatic
encephalopathy between 8 and 28 days, and
'subacute liver failure' describes patients who
develop hepatic encephalopathy within
5-12 weeks.
These ALF phenotypes have distinct
presentations and prognosis.8 Patients with
a hyperacute presentation have severe
coagulopathy, extremely elevated transaminase
levels, and only moderate (if any) increase in their
bilirubin levels.67,68 By contrast, patients who have
a subacute presentation have a severe jaundice,
mild-to-moderate coagulopathy, and only a mild
increase in transaminase levels. These patients
frequently have splenomegaly and ascites, and
a shrinking liver viewed on imaging. Hepatic
encephalopathy occurs very late, and is often a
manifestation of bacterial infection. Once hepatic
encephalopathy occurs, these patients have a
very short window, if any, in which to undergo
liver transplantation.69
In ALF, early identification of patients who
will not survive with medical support alone is of
utmost importance, as they will be priority
candidates for liver transplantation. Even at an
early stage, there are clinical features (i.e.
development of hepatic encephalopathy) that
may be helpful for risk stratification. As a general
rule, the development of hepatic encephalopathy
prompts critical care assessment and transfer to
a transplant centre.8
The adoption of a single threshold of hepatic
encephalopathy severity across the three
phenotypes of ALF does, however, seem too
simplistic. In patients with a subacute
presentation, even low-grade hepatic
encephalopathy may indicate poor prognosis,
whereas survival with medical support may
be excellent in the hyperacute setting with
concomitant hepatic encephalopathy of equal
severity. Recent proposals suggest that, in an
appropriate clinical context accompanied
by a decreasing liver volume, super urgent
listing could be undertaken in patients with
subacute liver failure even without the
presence of clinically overt hepatic

Mistakes in... 2020

1. Adam R, et al. 2018 Annual report of the European
Liver Transplant Registry (ELTR) - 50-year evolution of
liver transplantation. Transpl Int 2018; 31: 1293-1317.
2. European Association for the Study of the Liver. EASL
Clinical Practice Guidelines: Liver transplantation.
J Hepatol 2016; 64: 433-485.
3. Martin P, et al. Evaluation for liver transplantation in
adults: 2013 practice guideline by the American
Association for the Study of Liver Diseases and the
American Society of Transplantation. Hepatology
2014; 59: 1144-1165.
4. Russo FP, Ferrarese A and Zanetto A. Recent advances
in understanding and managing liver transplantation.
F1000Res 2016; 5.
5. Toniutto P, et al. Current challenges and future
directions for liver transplantation. Liver Int
2017; 37: 317-327.
6. European Association for the Study of the Liver,
European Association for the Study of Diabetes and
European Association for the Study of Obesity. EASLEASD-EASO Clinical Practice Guidelines for the
management of non-alcoholic fatty liver disease.
J Hepatol 2016; 64: 1388-1402.
7. European Association for the Study of the Liver. EASL
Clinical Practice Guidelines: Vascular diseases of the
liver. J Hepatol 2016; 64: 179-202.
8. European Association for the Study of the Liver. EASL
Clinical Practical Guidelines on the management of
acute (fulminant) liver failure. J Hepatol 2017; 66:
9. European Association for the Study of the Liver. EASL
Clinical Practice Guidelines: Management of alcoholrelated liver disease. J Hepatol 2018; 69: 154-181.
10. European Association for the Study of the Liver. EASL
Clinical Practice Guidelines for the management of
patients with decompensated cirrhosis. J Hepatol
2018; 69: 406-460.
11. European Association for the Study of the Liver. EASL
Clinical Practice Guidelines: Management of
hepatocellular carcinoma. J Hepatol 2018;
69: 182-236.
12. European Association for the Study of the Liver. EASL
Clinical Practice Guidelines on nutrition in chronic
liver disease. J Hepatol 2019; 70: 172-193.
13. Burra P, et al. Liver transplantation for alcoholic liver
disease in Europe: a study from the ELTR (European
Liver Transplant Registry). Am J Transplant
2010; 10: 138-148.
14. Testino G, et al. Management of end-stage alcoholrelated liver disease and severe acute alcohol-related
hepatitis: position paper of the Italian Society on
Alcohol (SIA). Dig Liver Dis 2020; 52: 21-32.
15. Kotlyar DS, et al. A critical review of candidacy for
orthotopic liver transplantation in alcoholic liver
disease. Am J Gastroenterol 2008; 103: 734-743.
16. Donckier V, et al. Ethical considerations regarding
early liver transplantation in patients with severe
alcoholic hepatitis not responding to medical
therapy. J Hepatol 2014; 60: 866-871.
17. Burra P and Germani G. Transplantation for acute
alcoholic hepatitis. Clin Liver Dis 2017; 9: 141-143.
18. Donnadieu-Rigole H, et al. Integration of an addiction
team in a liver transplantation center. Liver Transpl
2019; 25: 1611-1619.
19. Erard-Poinsot D, et al. Natural history of recurrent
alcohol-related cirrhosis after liver transplantation:
fast and furious. Liver Transpl 2020; 26: 25-33.
20. Lucey MR, et al. Minimal criteria for placement of
adults on the liver transplant waiting list: a report of a
national conference organized by the American
Society of Transplant Physicians and the American
Association for the Study of Liver Diseases. Liver
Transpl Surg 1997; 3: 628-637.
21. Burra P, et al. Long-term medical and psycho-social
evaluation of patients undergoing orthotopic liver
transplantation for alcoholic liver disease. Transpl Int
2000; 13 (Suppl 1): S174-S178.
22. Tandon P, et al. A shorter duration of pre-transplant
abstinence predicts problem drinking after liver
transplantation. Am J Gastroenterol 2009;
104: 1700-1706.
23. Burra P, et al. Common issues in the management of
patients in the waiting list and after liver
transplantation. Dig Liver Dis 2017; 49: 241-253.

24. Mathurin P, et al. Early liver transplantation for severe
alcoholic hepatitis. N Engl J Med 2011;
365: 1790-1800.
25. Cross TJ, et al. Liver transplantation in patients over
60 and 65 years: an evaluation of long-term outcomes
and survival. Liver Transpl 2007; 13: 1382-1388.
26. Lipshutz GS, et al. Outcome of liver transplantation in
septuagenarians: a single-center experience.
Arch Surg 2007; 142: 775-781.
27. Durand F, et al. Age and liver transplantation.
J Hepatol 2019; 70: 745-758.
28. Chalasani N, et al. The diagnosis and management of
nonalcoholic fatty liver disease: Practice guidance
from the American Association for the Study of Liver
Diseases. Hepatology 2018; 67: 328-357.
29. Nair S, Verma S and Thuluvath PJ. Obesity and its
effect on survival in patients undergoing orthotopic
liver transplantation in the United States. Hepatology
2002; 35: 105-109.
30. Hakeem AR, et al. Increased morbidity in overweight
and obese liver transplant recipients: a single-center
experience of 1,325 patients from the United
Kingdom. Liver Transpl 2013; 19: 551-562.
31. Leonard J, et al. The impact of obesity on long-term
outcomes in liver transplant recipients-results of the
NIDDK liver transplant database. Am J Transplant
2008; 8: 667-672.
32. Kim, HY and Jang JW. Sarcopenia in the prognosis of
cirrhosis: Going beyond the MELD score. World
J Gastroenterol 2015; 21: 7637-7647.
33. Ooi PH, et al. Sarcopenia in chronic liver disease:
impact on outcomes. Liver Transpl 2019;
25: 1422-1438.
34. Pinto Dos Santos D, et al. Sarcopenia as prognostic
factor for survival after orthotopic liver
transplantation. Eur J Gastroenterol Hepatol Epub
ahead of print, November 8, 2019. doi: 10.1097/
35. Carey EJ, et al. A multicenter study to define
sarcopenia in patients with end-stage liver disease.
Liver Transpl 2017; 23: 625-633.
36. Lai JC, et al. Development of a novel frailty index to
predict mortality in patients with end-stage liver
disease. Hepatology 2017; 66: 564-574.
37. Berzigotti A, Saran U and Dufour J-F. Physical activity
and liver diseases. Hepatology 2016; 63: 1026-1040.
38. Mazzaferro V, et al. Liver transplantation for the
treatment of small hepatocellular carcinomas in
patients with cirrhosis. N Engl J Med 1996;
334: 693-699.
39. Costentin CE, et al. Is it time to reconsider the Milan
criteria for selecting patients with hepatocellular
carcinoma for deceased-donor liver transplantation?
Hepatology 2019; 69: 1324-1336.
40. Duvoux C, et al. Liver transplantation for
hepatocellular carcinoma: a model including alphafetoprotein improves the performance of Milan
criteria. Gastroenterology 2012; 143: 986-994.e3.
41. Cillo U, et al. A multistep consensus-based approach
to organ allocation in liver transplantation: toward a
"blended principle model". Am J Transplant 2015;
15: 2552-2561.
42. Zanetto A, et al. Mortality in liver transplant recipients
with portal vein thrombosis - an updated metaanalysis. Transpl Int 2018; 31: 1318-1329.
43. Senzolo M, et al. Long-term outcome of splanchnic
vein thrombosis in cirrhosis. Clin Transl Gastroenterol
2018; 9: 176.
44. Nery F, et al. Causes and consequences of portal vein
thrombosis in 1,243 patients with cirrhosis: results of
a longitudinal study. Hepatology 2015; 61: 660-667.
45. D'Amico G, De Franchis R and Cooperative Study
Group. Upper digestive bleeding in cirrhosis. Posttherapeutic outcome and prognostic indicators.
Hepatology 2003; 38: 599-612.
46. Zanetto A, et al. Thromboelastometry
hypercoagulable profiles and portal vein thrombosis
in cirrhotic patients with hepatocellular carcinoma.
Dig Liver Dis 2017; 49: 440-445.
47. Rodriguez-Castro KI, et al. A prediction model for
successful anticoagulation in cirrhotic portal vein
thrombosis. Eur J Gastroenterol Hepatol 2019;
31: 34-42.
48. Zanetto A and Senzolo M. Management of thrombosis
in liver transplant candidate. In: Bezinover D and F
Saner FH (Eds). Critical Care for Potential Liver



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