Acute Liver Failure

Abstract

Acute liver failure is a rare hepatic emergent situation that affects primarily young people and has often a catastrophic or even fatal outcome. Definition of acute liver failure has not reached a universal consensus and the interval between the appearance of jaundice and hepatic encephalopathy for the establishment of the acute failure is a matter of debate. Among the wide variety of causes, acetaminophen intoxication in western societies and viral hepatitis in the developing countries rank at the top of the etiology list. Identification of the clinical appearance and initial management for the stabilization of the patient are of vital significance. Further advanced therapies, that require intensive care unit, should be offered. The hallmark of treatment for selected patients can be orthotopic liver transplantation. Apart from well-established treatments, novel therapies like hepatocyte or stem cell transplantation, additional new therapeutic strategies targeting acetaminophen intoxication and/or hepatic encephalopathy are mainly experimental, and some of them do not belong, yet, to clinical practice. For clinicians, it is substantial to have the alertness to timely identify the patient and transfer them to a specialized center, where more treatment opportunities are available. FIGURE 1. The 3 main well-established classifications for ALF. (i) Williams-Schalm and O'Grady system (ii) Bernuau system, and (iii) Mochida (Japanese) system. ALF indicates acute liver failure.

Retrospective evaluation of therapeutic plasma exchange treatment in a pediatric intensive care unit: Single‐center experience

“…The most common cause of acute liver failure is viral infections. 29 As liver regeneration begins and spontaneous recovery is likely soon after removing the toxins that cause liver damage, TPE is immensely effective for toxin clearance and for intercepting liver failure and its complications. With…”

“…Acute liver failure is a progressive and fatal disease that causes severe conditions such as encephalopathy, coagulopathy, and hypoglycemia. The most common cause of acute liver failure is viral infections 29 . As liver regeneration begins and spontaneous recovery is likely soon after removing the toxins that cause liver damage, TPE is immensely effective for toxin clearance and for intercepting liver failure and its complications.…”

Bilirubin—A Possible Prognostic Mortality Marker for Patients with ECLS

“…In addition to these complications, liver function plays a crucial role for the outcome of patients treated with ECLS [11]. Acute liver dysfunction and hypoxic liver injury are life-threatening events associated with a mortality rate of up to 80% [12,13]. Some authors tried to identify pre-ECLS factors with prognostic value, e.g., the "Survival after Veno-Arterial Extracorporeal Membrane Oxygenation" (SAVE) score, which may be a tool to predict the survival of patients receiving ECLS for refractory cardiogenic shock [7].…”

Early identification using the referral system prolonged the time to onset for hepatic encephalopathy after diagnosing severe acute liver injury

“…system in the case of SLI treatment is also recognized in the USA 10 . A review by Dr. Doulberis and his colleagues mentioned that the standard management for SLI indicates transferring the patient to a core center prior to HE development to prepare for liver transplantation 11 . As liver transplantation is the only established curative treatment for ALF 4,11,12 , this is an important procedure for improved prognosis; however, there is currently a shortage of liver donors.…”

“…A review by Dr. Doulberis and his colleagues mentioned that the standard management for SLI indicates transferring the patient to a core center prior to HE development to prepare for liver transplantation 11 . As liver transplantation is the only established curative treatment for ALF 4,11,12 , this is an important procedure for improved prognosis; however, there is currently a shortage of liver donors. Although introduction of presumed consent increases the numbers [13][14][15] , establishing an adequate organ supply based on appropriate indications for liver transplantation is crucial.…”