慢加急性肝功能衰竭（ACLF）是慢性肝病或肝硬化急性失代偿期的最严重形式，往往同时合并肝外器官功能衰竭，患者短期预后极差。ACLF的触发病因复杂多样，其分期及器官功能衰竭的类型和定义各不相同，目前尚无统一的ACLF诊断标准，难以直接预测和比较不同地域ACLF的总体发病率和预后情况。越来越多的研究证据表明，肝移植在ACLF外科治疗中发挥重要作用，但其价值尚存争议。目前ACLF具体的入院处理和治疗方案，包括ICU的监护治疗、器官功能的支持维护、肝移植手术指征和时机选择等方面，尚未形成统一的标准化流程或意见。ACLF患者是否应较其他潜在的肝移植等待受者在供者分配方面更具有优先权亦无定论。此外，人工肝支持系统在ACLF移植前桥接治疗中的应用价值尚需更多的前瞻性对照研究来进一步证实。因此，本文就肝移植在成人ACLF外科治疗中的指征选择、手术疗效及影响因素、手术时机选择、供肝资源分配及移植前桥接治疗等方面进行探讨，以期为ACLF肝移植治疗的未来临床研究提供新的方向。“,”Acute-on-chronic liver failure(ACLF)is the most severe form of acute decompensation that develops in patients with chronic liver disease or liver cirrhosis,and is always accompanied by one or more extrahepatic organ failure, and has an extremely poor short-term prognosis. The causes triggering ACLF are complex and diverse,and the clinical stage and the type and the definition of organ failure differ greatly from one another. Therefore, a universally accepted diagnostic criteria for ACLF is yet to be defined, and the epidemiological data and patient outcomes on ACLF are not easy to predict and compare among different regions. Accumulating evidence has shown that liver transplantation(LT)plays a significant role in the surgical treatment of patients with ACLF,but its clinical value is still controversial. The specific management and treatment strategy after the admission of patients with ACLF has not yet formed a unified and standardized process or opinions, which includes the monitoring in the ICU,the support and maintenance of organ functions, the selection of the surgical indication and the timing for LT and so on. Moreover, there still exists many controversies concerning, for example, whether patients with ACLF should receive greater priority for organ allocation compared to other potential candidates on the waiting list. Besides, more prospective controlled studies are urgently needed to investigate the role of the artificial liver support system in the bridging therapy to LT. The aim of this article is to review the indication selection of patients with ACLF suitable for LT,the survival outcomes and prognostic factors after LT, the selection of timing, the organ allocation policy and the bridging therapy to LT, which intends to provide new direction for designing the future clinical studies on LT in patients with ACLF.