Luminary Learning Gastrointestinal Disorder- Issue 1

10  • LUMINARY LEARNING: GASTROINTESTINAL DISORDERS after LT, pretransplant episodes of HE are associated with impair of posttransplant neurological outcome [61]. Data are limited for liver transplant outcomes in patients with HE in the setting of ACLF. Although posttransplant survival rates for ACLF have been reported to be 80–90%, long- term outcome is scarce [10]. Patients with ACLF usually have high MELD scores but they may have LT contraindication such as active infection, and hemodynamic instability with the need for inotropes. With the current organ allocation system using the MELDNa score, HE does not result in a higher prioritization for LT. However, there are cases with severe HE who would benefit from LT, particularly in the context of ACLF. A new scoring system, chronic liver failure consortium ACLF score (CLIF-C ACLFs), has been developed and validated in cirrhotic patients with ACLF. This score will need further evaluation to determine whether it can accurately discriminate or rank individuals according to their mortality risk, before it could be utilized for organ allocation in ACLF setting [62]. References 1. Amodio P, Del Piccolo F, Petteno E, et al. Prevalence and prognostic value of quantified electroencephalogram (EEG) alterations in cirrhotic patients. J Hepatol. 2001;35(1):37–45. 2. Romero-Gómez M, Boza F, Garcı́a-Valdecasas MS, Garcı́a E, Aguilar-Reina J. Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy. Am J Gastroenterol. 2001;96(9):2718–23. 3. Boyer TD, Haskal ZJ, American Association for the Study of Liver Diseases. The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension. Hepatology. 2005;41(2):386–400. 4. Stepanova M, Mishra A, Venkatesan C, Younossi ZM. In-hospital mortality and economic burden associated with hepatic encephalopathy in the United States from 2005 to 2009. Clin Gastroenterol Hepatol. 2012;10(9):1034– 1041.e1031. 5. Stewart CA, Malinchoc M, KimWR, Kamath PS. Hepatic encephalopathy as a predictor of survival in patients with end-stage liver disease. Liver Transplant. 2007;13(10):1366–71. 6. Bajaj JS, O’Leary JG, Tandon P, et al. Hepatic encephalopathy is associated with mortality in patients with cirrhosis independent of other extrahepatic organ failures. Clin Gastroenterol Hepatol. 2017;15(4):565–574.e564. 7. Asrani SK, Simonetto DA, Kamath PS. Acute-on-chronic liver failure. Clin Gastroenterol Hepatol. 2015;13(12):2128– 39. 8. Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426–37. 1437.e1421–9. 9. Bajaj JS, O’Leary JG, Reddy KR, et al. Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatology. 2014;60(1):250–6. 10. Sarin SK, Kumar A, Almeida JA, et al. Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL). Hepatol Int. 2008;3(1):269. 11. Jalan R, Yurdaydin C, Bajaj JS, et al. Toward an improved definition of acute-on-chronic liver failure. Gastroenterology. 2014;147(1):4–10. 12. Allen AM, KimWR, Moriarty JP, Shah ND, Larson JJ, Kamath PS.Time trends in the health care burden andmortality of acute on chronic liver failure in the United States. Hepatology. 2016;64(6):2165–72. 13. Fichet J, Mercier E, Genee O, et al. Prognosis and 1-year mortality of intensive care unit patients with severe hepatic encephalopathy. J Crit Care. 2009;24(3):364–70. 14. Cordoba J, Ventura-Cots M, Simon-Talero M, et al. Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF). J Hepatol. 2014;60(2):275–81. 15. ShawcrossDL, DaviesNA,Williams R, JalanR. Systemic inflammatory response exacerbates theneuropsychological effects of induced hyperammonemia in cirrhosis. J Hepatol. 2004;40(2):247–54. 16. Jalan R, Gines P, Olson JC, et al. Acute-on chronic liver failure. J Hepatol. 2012;57(6):1336–48. 17. Jaeschke H. Reactive oxygen and mechanisms of inflammatory liver injury: present concepts. J Gastroenterol Hepatol. 2011;26(Suppl 1):173–9.