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Volume 42 Issue 3
Mar.  2026
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Article Navigation >  Journal of Clinical Hepatology  > 2026  >  42(3): 535-540

Evaluation and decision-making for liver transplantation in acute-on-chronic liver failure： Evolution， integration， and challenges

DOI: 10.12449/JCH260307

  • Fourth Department of Liver Disease Center，Beijing YouAn Hospital，Capital Medical University，Beijing 100069，China

Research funding:

Capital’s Funds for the Health Improvement and Research (2024-1-2181);

Beijing Hospitals Authority’s Ascent Plan (DFL20221501);

Prevention and Control of Emerging and Major Infectious Diseases-National Science and Technology Major Project (2025ZD01906501)

More Information
  • Corresponding author: CHEN Yu， chybeyond1071@ccmu.edu.cn （ORCID： 0000-0003-1906-7486）
  • Received Date: 2025-12-16
  • Accepted Date: 2026-01-22
  • Published Date: 2026-03-25
    Abstract
  • Acute-on-chronic liver failure （ACLF） is a syndrome of acute liver function decompensation in patients with chronic liver disease and is characterized by a high short-term mortality rate. Liver transplantation is an effective radical treatment method for ACLF and can significantly improve the survival rate of patients. However， in the context of a shortage of donor organs globally， how to achieve a balance between saving lives and avoiding futile transplantation while optimizing organ utilization is a critical challenge in clinical decision-making. This article systematically reviews the evolution of the evaluation and decision-making system for liver transplantation in ACLF patients and points out s that the core of this system has shifted from relying solely on the MELD score to a model based on multidimensional prognostic assessment， dynamic evaluation， and multidisciplinary collaboration. In the future， the integration of Eastern and Western criteria， the application of artificial intelligence for precise prediction， and the establishment of a more equitable priority and allocation system will be the key directions for development in this field.

     

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