Acute clinical deterioration in patients with chronic liver disease is called acute on chronic liver failure (ACLF). Principles of management of ACLF consist of early identifying etiology of liver disease, rapid intervention of precipitating event and discreet intensive cares. Despite medical intensive cares, if liver failure progresses, liver transplantation could be the other option. Also, liver transplantation is the only treatment that offers a chance of cure for hepatocellular carcinoma (HCC) and the underlying liver cirrhosis simultaneously. Emergent living donor liver transplantation (LDLT) can be performed for patients with acute liver failure and improves survival rate, especially in circumstances which liver graft is often not available because of deceased donors are not affordable. Here, we describe a chronic hepatitis B patient who developed ACLF accompanying early HCC. Because he did not improved with medical care, he received emergent LDLT. After LDLT, he showed great improvement without critical complications.

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• Systematic review with meta‐analysis: liver transplant provides survival benefit in patients with acute on chronic liver failure
  Mohamed A. Abdallah, Muhammad Waleed, Matthew G. Bell, Morgan Nelson, Robert Wong, Vinay Sundaram, Ashwani K. Singal
  Alimentary Pharmacology & Therapeutics.2020; 52(2): 222.     CrossRef