Last update:
07-Jul-2019

Acute liver failure (ALF) is a rare syndrome with a high short-term mortality rate. It is characterized by hepatic dysfunction of acute onset with encephalopathy and a significant degree of coagulopathy in patients without pre-existing liver impairment. The predominant cause worldwide is acute viral hepatitis types A, B (±D), and E. In several high-income countries, however, the frequency of drug induced ALF, especially that due to paracetamol overdose, is increasing progressively and is already the most common cause. Special treatment is rarely available for ALF. Nacetylcysteine is used for paracetamol toxicity and nucleos(t)ide analogues in severe hepatitis B. In most cases, the only option is supportive care, which is based on the early recognition and treatment of the complications of ALF such as hypovolemia, acute renal injury, intracranial hypertension, infections and catabolism. The prognosis is often uncertain as it depends on a variety of parameters such as the etiology, the patient's age, the time from the onset of jaundice to liver encephalopathy and the speed of administration of special or supportive treatment. In order to optimize the determination of the prognosis and the selection of patients requiring urgent liver transplantation, a set of criteria has been developed based on the parameters above. Patients with adverse prognostic factors should be transferred rapidly to specialized centers, as transplantation achieves 80% one-year survival.

Key words: Acute liver failure, Acute viral hepatitis, Drug induced liver injury, Liver transplantation.