Liver transplantation beat being declined in severe ACLF, except at five or six organ failures; an eight-week course looks sufficient in acute hepatitis C

The edition in brief

In a prospective study across 63 liver transplant centres, 612 patients with decompensated cirrhosis who were transplanted were compared with 144 patients with acute-on-chronic liver failure grade 2 or 3 who were declined. One-year death occurred in 73% of declined patients with ACLF-2 and 88% with ACLF-3. Among the transplanted, case fatality without re-transplant was 21% with ACLF-3 (42% with five or six organ failures), 10.5% with ACLF-2 and 9% without ACLF. A meta-analysis of 14 mostly single-arm studies (1,078 patients) of dual direct-acting antiviral therapy in acute or recently acquired hepatitis C found a pooled SVR12 of 97.7%, with 84.8% at 4 weeks, 91.7% at 6 weeks, 99.4% at 8 weeks and 97.4% at 12 weeks. A single-arm phase 2 study of eight weeks of bemnifosbuvir and ruzasvir in 275 treatment-naive patients gave SVR12 of 90% by intention to treat and 98% per protocol. A pooled analysis of five cohorts (162 children) found subcutaneous infliximab after intravenous switch maintained remission in about 90%, with low-certainty evidence. A pearl on liver cancer surveillance after hepatitis C cure closes the edition.