*Purpose: Patients with advanced liver disease, particularly those with acute decompensation or acute liver failure (ALF) requiring intensive care unit (ICU) admission, are at elevated risk for in-hospital and short-term mortality. Historically less than half of these patients survive hospitalization. The medical intensive liver unit (MILU), a novel subspecialty ICU focused on the care of critically ill patients with advanced liver disease, opened at our center on August 27, 2018. Quality metrics pertinent to the management of these patients include standardization of care, transplant-free survival, length of stay, resource utilization, and timing and rate of liver transplantation (LT). We aim to describe the structure of this novel program and to report early outcomes.

*Methods: Consecutive patients admitted to the MILU at a United States quaternary care transplantation center between August 27 and November 25, 2018 were enrolled in a prospective patient registry. Patients were followed from admission to hospital discharge, LT or death. A multi-disciplinary team management strategy was implemented in the MILU, including transplant hepatologists, intensivists, nurses, transplant surgeons, pharmacists, physical therapists and dieticians. Educational protocols were developed for all caregivers focused on the improved, evidence-based care of patients with complications of acute and chronic liver disease.

*Results: To date, 147 patients have been admitted to the MILU. Of these patients, 57 were found to be potential candidates for LT (undergoing active evaluation during their MILU admission, or approved and/or listed for LT). Nine candidates have since undergone successful LT, accounting for 30% (9/30) of all transplants done at our center during the same time period. Seventeen of these patients underwent evaluation for ALF, including 2 patients with acetaminophen toxicity, 3 patients with acute hepatitis A virus infection, 10 patients with mushroom poisoning, 1 patient with drug induced liver injury and 1 patient with wilson disease. Of the 17 ALF patients, 4 underwent successful LT; the remaining 13 recovered without transplant. Overall in-hospital mortality for potential LT candidates was 21% (12/57 patients); 75% survived transplant-free (36/48 patients).

*Conclusions: The MILU represents a novel sub-specialty model for the improved medical care of patients with liver disease. Through focused multi-disciplinary care and early subspecialty interventions, the MILU team aims to optimize the medical status of critically ill patients as part of an effort to offer bridges to LT. Updated data will be presented.

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