Acute liver failure: Summary of a workshop

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Hepatology. 2008 Apr;47(4):1401-15.

Acute liver failure: Summary of a workshop.

Lee WM, Squires RH Jr, Nyberg SL, Doo E, Hoofnagle JH.

Division of Digestive and Liver Diseases, University of Texas Southwestern

Medical School, Dallas, TX 75390-8887, USA. .Lee@...

Acute liver failure (ALF) is a rare but challenging clinical syndrome with

multiple causes; a specific etiology cannot be identified in 15% of adult and

50% of pediatric cases. The course of ALF is variable and the mortality rate is

high. Liver transplantation is the only therapy of proven benefit, but the

rapidity of progression and the variable course of ALF limit its use. Currently

in the United States, spontaneous survival occurs in approximately 45%, liver

transplantation in 25%, and death without transplantation in 30% of adults with

ALF. Higher rates of spontaneous recovery (56%) and transplantation (31%) with

lower rates of death (13%) occur in children. The outcome of ALF varies by

etiology, favorable prognoses being found with acetaminophen overdose, hepatitis

A, and ischemia (approximately 60% spontaneous survival), and poor prognoses

with drug-induced ALF, hepatitis B, and indeterminate cases (approximately 25%

spontaneous survival). Excellent intensive care is critical in management of

patients with ALF. Nonspecific therapies are of unproven benefit. Future

possible therapeutic approaches include N-acetylcysteine, hypothermia, liver

assist devices, and hepatocyte transplantation. Advances in stem cell research

may allow provision of cells for bioartificial liver support. ALF presents many

challenging opportunities in both clinical and basic research.

PMID: 18318440 [PubMed - indexed for MEDLINE]

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[Guest guest]

Hepatology. 2008 Apr;47(4):1401-15.

Acute liver failure: Summary of a workshop.

Lee WM, Squires RH Jr, Nyberg SL, Doo E, Hoofnagle JH.

Division of Digestive and Liver Diseases, University of Texas Southwestern

Medical School, Dallas, TX 75390-8887, USA. .Lee@...

Acute liver failure (ALF) is a rare but challenging clinical syndrome with

multiple causes; a specific etiology cannot be identified in 15% of adult and

50% of pediatric cases. The course of ALF is variable and the mortality rate is

high. Liver transplantation is the only therapy of proven benefit, but the

rapidity of progression and the variable course of ALF limit its use. Currently

in the United States, spontaneous survival occurs in approximately 45%, liver

transplantation in 25%, and death without transplantation in 30% of adults with

ALF. Higher rates of spontaneous recovery (56%) and transplantation (31%) with

lower rates of death (13%) occur in children. The outcome of ALF varies by

etiology, favorable prognoses being found with acetaminophen overdose, hepatitis

A, and ischemia (approximately 60% spontaneous survival), and poor prognoses

with drug-induced ALF, hepatitis B, and indeterminate cases (approximately 25%

spontaneous survival). Excellent intensive care is critical in management of

patients with ALF. Nonspecific therapies are of unproven benefit. Future

possible therapeutic approaches include N-acetylcysteine, hypothermia, liver

assist devices, and hepatocyte transplantation. Advances in stem cell research

may allow provision of cells for bioartificial liver support. ALF presents many

challenging opportunities in both clinical and basic research.

PMID: 18318440 [PubMed - indexed for MEDLINE]

_________________________________________________________________

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