慢加急性肝衰竭的肝移植治疗

慢加急性肝衰竭（ACLF）是肝衰竭的一种特殊类型，以进展迅速、常伴有全身多个器官衰竭为主要特点。目前对于ACLF患者主要采用系统综合的内科支持治疗，促进肝脏再生。而对于内科治疗无效，迅速进展至多器官衰竭者，肝移植是唯一有潜在治愈可能的治疗方式。但考虑到不同患者的病情进程、预后转归的差异以及我国供肝的紧缺性，积极预防慢性肝病患者ACLF的触发因素，筛选出最可能获益的肝移植受者以及肝移植围手术期的精细管理显得尤为重要。本文拟从ACLF的精确评估、肝移植手术指征的精准把握及围手术期的精细管理等方面探讨肝移植在ACLF中的应用，以优化ACLF肝移植的治疗策略。

Liver transplantation for acute-on-chronic liver failure

Acute-on-chronic liver failure (ACLF) is a specific category of liver failure, which is mainly characterized by rapid progression and multiple organ failure. At present, patients with ACLF are mainly given with systematic and comprehensive medical therapy to promote liver regeneration. However, liver transplantation is the only potentially curative treatment for patients who failed to respond to medical treatment and rapidly progress into multiple organ failure. Considering the differences of disease progression and clinical prognosis, and the shortage of donor liver in China, it is necessary to actively prevent the triggering factors of ACLF in patients with chronic liver diseases, screen out the recipients who are most likely to benefit from liver transplantation and deliver precision management during perioperative period of liver transplantation. In this article, the application of liver transplantation in ACLF was illustrated from the perspectives of accurate evaluation of ACLF, proper control of liver transplantation indications and meticulous perioperative management, aiming to optimize the therapeutic strategy of liver transplantation in patients with ACLF.