N-acetylcysteine therapy for ischaemic hepatic failure: a successful antidote

Abstract

Acute liver failure (ALF) is characterised by severe liver injury with the onset of coagulopathy (INR ≥1.5) and encephalopathy in the absence of pre-existing liver disease. It is associated with a high mortality rate of 10-57%, which is largely driven by multi-organ failure, sepsis and cardiac arrhythmia. Current management focuses on identifying and treating the aetiology, providing supportive care and monitoring liver function. The use of N-acetylcysteine (NAC) therapy is well-studied in the treatment of paracetamol toxicity but is controversial in other causes of ALF. We reported the first case of ischaemic hepatic failure secondary to prolonged portal vein occlusion treated with 72 hours of NAC therapy. Although ischaemic hepatopathy is a relatively uncommon cause of ALF, it is associated with a high mortality rate. The case highlights how early use of NAC therapy may improve hepatic serology biomarkers and should warrant consideration in ALF secondary to ischaemic hepatopathy.

Acute Liver Failure Guidelines

“…Although most patients listed as status 1A receive a timely organ offer, a recent analysis of the UNOS database shows that 18.2% of patients died or became too sick for transplantation (233). This led to the consideration of living donor grafts and ABO-incompatible deceased organ grafts.…”