How to manage: acute-on-chronic liver failure

Acute on chronic liver failure has emerged as a distinct clinical entity over the past few decades. While mortality remains highest for patients who develop liver and multiple non-liver organ failures, earlier recognition of the syndrome, including identification and management of precipitating factors, as well as a systematic approach to the management of organ failures, is leading to improved patient outcomes. Liver transplantation has emerged as a life-saving intervention for some patients but requires timely prognostication and discussion with local transplant centres. In this review, we aim to provide a practical summary to support the management of this patient cohort.