Expert consensus on perioperative management of liver transplantation in adults with acute-on-chronic liver failure

Abstract Acute-on-chronic liver failure (ACLF) is a syndrome in which acute liver failure with extrahepatic organ failure occurs on chronic liver disease. Recently, liver transplantation is the only effective treatment for ACLF. There is still room for discussion on the optimal surgery timing for ACLF, perioperative infection prevention and control, and maintenance of nutrition and organ function. The Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association and Enhanced Recovery of Liver Transplantation Group of Enhanced Recovery after Surgery Committee of Chinese Research Hospital Association invited relevant experts to discuss about the perioperative management of ACLF liver transplantation in areas including surgery timing, organ protection, nutritional support, infection prevention and control, rehabilitation exercises, regulation of the internal environment, etc. An expert consensus was developed as reference for clinicians.