The condition of the patient could be “reversible” through early intensive management of these reversible factors. The systemic inflammatory response seems to be a critical factor in the development of ACLF. However, there are many cases without a definite trigger. It is often related to trigger events, such as exacerbation of hepatitis, bacterial infections, and active alcoholism. It has a higher short-term mortality than that predicted by the severity of the underlying chronic liver disease. ACLF is a separate syndrome characterized by acute decompensation of chronic liver disease combined with the failure of other organs. ALF is defined as severe acute liver injury accompanied by coagulopathy (INR ≥ 1.5) and any degree of HE in patients without preexisting liver disease. Specific conditions that reduce the predictive power of the MELD score Specific conditions that reduce the predictive power of the MELD scoreĪCLF is different from acute liver failure (ALF) or the progression of chronic decompensated LC. Probable bias based on the inter-laboratory variability of measurement methods for serum creatinine, bilirubin, and INR has also been pointed out. To overcome this, modified MELD with cystatin-C instead of creatinine and MELD 3.0, with sex as an additional factor, was also announced. Several studies have suggested that glomerular filtration in women may be underestimated owing to their reduced muscle mass compared to that in men. In the MELD-based allocation system, it has been frequently pointed out that women are less likely to receive LT than men, and that the mortality rate while waiting for LT is significantly higher in women than in men. In this case, even if the serum creatinine level is normal, it cannot be concluded that the renal function is normal. Severe muscle wasting in patients with ESLD can reduce serum creatinine levels. Serum creatinine is not a good indicator for assessing renal dysfunction because it is influenced by extra-renal factors, such as muscle mass, sex, age, and ethnicity. The Korean Network for Organ Sharing changed the basis of the liver allocation system from CTP classification to MELD in 2016. Since 2002, the Model for End-stage Liver Disease (MELD) score, which consists of all objective indicators, has replaced the CTP classification for the basis of the liver allocation system in the UNOS.
However, some disadvantages of CTP classification exist, such as the existence of several subjective parameters, and the final result is determined by three classes (A, B, and C). Previously, the Child-Turcotte-Pugh (CTP) classification was used as the basis for the United Network for Organ Sharing (UNOS) organ allocation system. Several scoring systems have been proposed to predict mortality in patients with ESLD, and these scoring systems have also been used as a basis for allocating livers of brain death for LT. Thomas Starzl performed the first human liver transplantation (LT) in 1963, LT has been considered the only definitive treatment for decompensated end-stage liver disease (ESLD).
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