Implications for Transplantation in Acute-on-Chronic Liver Failure: Determining a Course of Action
This activity consists of a recorded presentation from the "Essentials of Oncology, Solid Organ and Blood/Marrow Transplant Management for the Health Care Team" conference held in Scottsdale, Ariz., March 14–15, 2022.
Acute deterioration of liver function with extrahepatic organ failure in an individual with chronic liver failure (acute-on-chronic liver failure; ACLF) is a high-mortality complication requiring critical care support and rapid prognostication to determine the role of liver transplant. This session will help participants to better determine the role and optimal timing of liver transplant in ACLF. It will review precipitators of ACLF associated with poorer outcomes, including bacterial infections and hepatitis B virus, and will explore posttransplant outcomes and predictors. The accuracy of current scoring systems for assessing the severity of disease and predicting survival will be discussed, including the Model for End-stage Liver Disease (MELD) score and the Chronic Liver Failure Consortium Organ Failure (CLIF-C OF) score.
This activity is provided by OptumHealth Education.
There was no commercial support for this activity.
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This activity is designed to meet the educational needs of case managers, nurses, pharmacists, pharmacy technicians, physicians, psychologists, social workers, dietitians, and other health care professionals who are interested in liver transplantation for individuals with acute-on-chronic liver failure (ACLF).
At the end of this educational activity, participants should be able to:
- Review the clinical presentation, contributing factors, incidence, prognosis and outcomes seen in acute-on-chronic liver failure (ACLF).
- Describe ACLF scoring systems, including grades associated with high mortality rates, and the ability of these scores to predict mortality in ACLF.
- Identify how to determine which patients with ACLF are suitable candidates for liver transplantation and the pre- and posttransplant predictors associated with survival.
- Review the importance of timing, positive and negative indicators, concomitant disease, organ failure, and bacterial and viral infection in transplant algorithms for ACLF.
Vinay Sundaram, MD, MSc
Director, Hepatology Outcomes Research
Assistant Medical Director, Liver Transplantation
Cedars-Sinai Medical Center
Los Angeles, CA
About the presenter
Dr. Vinay Sundaram is an associate professor of medicine and director of hepatology outcomes research at Cedars-Sinai Medical Center. He completed medical school at New York University school of medicine, followed by residency at the University of Virginia, gastroenterology fellowship at the University of Pittsburgh, and transplant hepatology fellowship at Beth Israel deaconess medical center. He has published more than 100 manuscripts and abstracts, including multiple first authored papers regarding transplantation in the setting of acute-on-chronic liver failure in prestigious journals such as Gastroenterology, Hepatology, Journal of Hepatology, and Liver Transplantation. He currently serves on the AASLD acute on chronic liver failure special interest group steering committee and is the current chair of the AASLD membership and mentorship committee. He is also on the editorial boards of Hepatology, American Journal of Gastroenterology, Liver Transplantation, and Hepatology Communications, and previously served as on the UNOS membership and professional standards committee.
Elizabeth Albert, MD
Clinical Activity Manager
Eden Prairie, MN
Matthew Cooper, MD
President, UNOS Board of Directors;
Director, Kidney and Pancreas Transplantation
Medstar Georgetown Transplant Institute;
Professor of Surgery
Georgetown University School of Medicine
Rebecca Gleason, RN, CCM
Eden Prairie, MN
Alan N. Langnas, DO, FACS
Professor of Surgery
Director, Center of Transplantation
Chief, Section of Transplantation,
Department of Surgery
University of Nebraska Medical Center;
Director of Liver Transplantation
C. Fred LeMaistre, MD
Senior Vice President
Senior Vice President, Market Operations
Tina Rydland, PharmD
Disclosures of relevant financial relationships
In accordance with the Accreditation Council for Continuing Medical Education's (ACCME) Standards for Integrity and Independence in Accredited Continuing Education, OptumHealth Education (OHE) requires all those in control of educational content to disclose their financial relationships with ineligible companies within the prior 24 months. Ineligible companies are defined by the ACCME as companies whose primary business is producing, marketing, selling, re-selling, or distributing health care products used by or on patients. Individuals must disclose all financial relationships, regardless of the amount, with ineligible companies and regardless of their view of the relevance of the relationship to the education. OHE ensures that the content is independent of commercial bias.
Dr. Sundaram has indicated that he is a consultant and is on the advisory board for Saol Therapeutics and is part of the speakers’ bureau for AbbVie, Gilead, Intercept and Salix.
The activity planners have no financial relationships to disclose.
Method for calculating CE credit
CE credit was calculated by the complexity of content.
In support of improving patient care, OptumHealth Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the health care team.
Credit designation statements
This activity was planned by and for the health care team, and learners will receive 0.75 Interprofessional Continuing Education (IPCE) credits for learning and change.
The participant will be awarded up to 0.75 contact hour(s) of credit for attendance and completion of supplemental materials.
The American Academy of Nurse Practitioners Certification Program (AANPCP) accepts credit from organizations accredited by the ACCME and ANCC.
This activity is approved for 0.75 contact hour(s) ([0.075] CEU) in states that recognize ACPE.
Attending the full program will earn 0.75 contact hour(s).
Unique Activity Number(s): JA0007123-0000-22-144-H01-P/T
OptumHealth Education designates this enduring activity for a maximum of 0.75 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
The American Academy of Physician Assistants (AAPA) accepts credit from organizations accredited by the ACCME.
The Commission for Case Manager Certification has approved this program for a maximum of 0.75 clock hour(s) for Certified Case Managers (CCM).
Completion of this RD/DTR profession-specific or IPCE activity awards CPEUs (One IPCE credit=One CPEU).
If the activity is dietetics-related but not targeted to RDs or DTRs, CPEUs may be claimed which are commensurate with participation in contact hours (One 60 minute hour=1 CPEU).
RD's and DTRs are to select activity type 102 in their Activity Log. Performance indicator selection is at the learner's discretion.
Psychologists and social workers
Participants must have attended the entire Web-based activity and completed an evaluation to receive a certificate. Partial credit is not available.
OptumHealth Education is approved by the American Psychological Association (APA) to offer continuing education for psychologists. OptumHealth Education maintains responsibility for this program. 0.75 CE hour.
As a Jointly Accredited Organization, OptumHealth Education is approved to offer social work continuing education by the Association of Social Work Boards (ASWB) Approved Continuing Education (ACE) program. Organizations, not individual courses, are approved under this program. State and provincial regulatory boards have the final authority to determine whether an individual course may be accepted for continuing education credit. OptumHealth Education maintains responsibility for this course. Social workers completing this course receive 0.75 enduring continuing education credit.
A certificate of attendance will be provided to learners upon completion of activity requirements, enabling participants to register with licensing boards or associations that have not been preapproved for credits. To apply for credit types not listed above, participants should use the procedure established by the specific organization with which they wish to obtain credit.
- 0.75 ACPE - Pharmacists
- 0.75 ACPE - Pharmacy Technicians
- 0.75 AMA - Physicians
- 0.75 ANCC - Nurses
- 0.75 APA - Psychologists
- 0.75 Attendance - General Attendance
- 0.75 CCMC - General - Case Managers
- 0.75 CDR - Dietitians
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