Liver transplantation in the most severely ill cirrhotic patients

In 2011 we published an observational study where patients with ACLF-3 remained on the waiting list despite suffering from active pneumonia. Of the initially nine included patients only six patients improved under our proposed goal-directed therapy and subsequently underwent liver transplantation (LT). Before the development of pneumonia, the patients must have mild symptoms of chronic liver failure, corresponding to Child-Pugh-Turcotte class A with a median MELD of 12. All patients subsequently developed severe liver dysfunction that fulfilled the criteria for ACLF-3 [2].