• Jonel Trebicka, Michael Praktiknjo, Kai-Henrik Peiffer, Andreas Pascher, Martin Sebastian Schulz, and Frank Erhard Uschner.
• Dtsch Arztebl Int. 2025 Feb 21 (Forthcoming).

BackgroundCirrhosis is the end stage of chronic liver disease. Cirrhosis causes portal hypertension, which, in turn, can lead to acute on chronic liver failure (ACLF), which is defined as acute decompensation combined with failure of the liver, coagulation system, kidneys, lungs, and/or circulatory system, or hepatic encephalopathy.MethodsThis review is based on a selective literature search for international publications in the NCBI database using the keywords "liver cirrhosis" and "ACLF." Valid guidelines (up to June 2024) were also included.ResultsCirrhosis is present in approximately 1% of all hospital admissions in Germany, and complications of cirrhosis cause an estimated 1 million deaths worldwide each year. ACLF, the most severe form of decompensated liver cirrhosis, bears a 28-day mortality of 45% and affects 35% of all patients hospitalized for decompensated cirrhosis. Its precipitating factors are infection, alcohol overuse, bleeding, and drug-induced encephalopathy (benzodiazepines or opioids). No drugs or other treatments for ACLF have been approved; only its etiology and precipitating factors are amenable to treatment.ConclusionLiver transplantation is currently the only curative option for ACLF but is not suitable for all patients because of the narrow therapeutic window and the common presence of contraindications. Prospective data are lacking that would aid in the selection of patients for liver transplantation so that post-transplantation survival rates can be improved.

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