What is ACLF?
Acute-on-Chronic Liver Failure (ACLF) is one of the most severe syndromes in hepatology. The APASL defines it as acute hepatic insult superimposed on chronic liver disease, presenting with jaundice (bilirubin ≥5 mg/dL) and coagulopathy (INR ≥1.5), complicated by ascites and/or encephalopathy within 4 weeks. Dr. Chetan Kalal is a leading ACLF specialist at Gleneagles Hospital Mumbai and has contributed to APASL AARC consensus research.
AARC Grading
Grade 1 (AARC score 5–7): 28-day mortality approximately 15–20% with optimal medical therapy.
Grade 2 (score 8–10): Intermediate mortality; intensive care mandatory.
Grade 3 (score 11–15): Mortality exceeds 70% without liver transplantation.
Common Precipitants in India
- Hepatitis B reactivation
- Alcohol-related liver disease flare
- Bacterial infections (SBP, pneumonia)
- Superimposed drug-induced or herbal liver injury
- Hepatitis E superinfection
Treatment
Grade 1: Treat the precipitant, nutritional support, lactulose and rifaximin for encephalopathy, prophylactic antibiotics, careful fluid management.
Grade 2–3: Immediate tertiary referral. Evaluate for liver transplantation within 7–10 days. Living donor liver transplant (LDLT) is the preferred route in India.
FAQs
Can ACLF survive without transplant?
Grade 1 ACLF can recover with medical management. Grade 2–3 carries high mortality without transplantation. Early AARC scoring and 72-hour reassessment is essential.
Best ACLF specialist in Mumbai?
Dr. Chetan Kalal at Gleneagles Hospital Mumbai specialises in ACLF management and liver transplant evaluation. Referrals accepted nationally and internationally.
Author: Dr. Chetan Kalal, first DM Hepatologist of Maharashtra. ORCID 0000-0002-5284-7890. See also: ACLF service page.
About the Author
Dr. Chetan Kalal — MBBS, MD (Internal Medicine), DM Hepatology (ILBS, New Delhi) — is the First DM Hepatologist of Maharashtra and Associate Director, Hepatology & Liver Transplant, at Gleneagles Hospital Mumbai. He has 26 peer-reviewed publications and serves on the APASL AARC Expert Panel. Fellow, National Academy of Medical Sciences (FNAMS). Learn more · Book appointment
