Kumar R, Anand U, Priyadarshi RN. Liver transplantation in acute liver failure: Dilemmas and challenges. World J Transplant 2021; 11(6): 187-202 [PMID: 34164294 DOI: 10.5500/wjt.v11.i6.187]
Corresponding Author of This Article
Ramesh Kumar, MD, Associate Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Ramesh Kumar, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Utpal Anand, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Rajeev Nayan Priyadarshi, Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, Bihar, India
Author contributions: Kumar R designed and wrote the manuscript, and collected relevant data; Anand U and Priyadarshi RN contributed in data collection and manuscript writing; all authors have read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MD, Associate Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, Bihar, India. docrameshkr@gmail.com
Received: February 1, 2021 Peer-review started: February 1, 2021 First decision: March 8, 2021 Revised: March 17, 2021 Accepted: May 24, 2021 Article in press: May 24, 2021 Published online: June 18, 2021
Core Tip
Core Tip: Liver transplantation (LT) is a lifesaving procedure for patients with acute liver failure (ALF). Its use, however, is constrained by the absence of reliable prognostic models that hampers the selection of transplant candidates in a timely and precise manner. The survival of medically treated ALF patients has increased over time, but the criteria for LT remain the same. No clear advantage of LT in acetaminophen-associated ALF appears to be present. The other problems associated with LT in ALF are diagnostic dilemmas, shortage of graft, waiting list contraindications, vaguely defined delisting criteria, pre-transplant assessment time limits, ethical concerns, and comparatively poor post-transplant outcomes. Therefore, there is a desperate need to establish accurate prognostic models and explore the roles of alternative therapies to enhance transplant-free survival and fill the gap produced by the shortage of graft.
