Acute Liver Failure

 Acute liver failure (ALF) is a rare syndrome defined by a rapid decline in hepatic function characterised by jaundice, coagulopathy (INR >1.5), and hepatic encephalopathy in patients with no evidence of prior liver disease.The interval from the onset of jaundice to the development of encephalopathy occurs within 24 to 26 weeks and may further classify ALF into categories based on hyperacute, acute, or subacute presentations.Drug-induced liver injury is a diagnosis of exclusion; a thorough history-taking and workup should be performed to rule out other possible etiologies Liver biopsy should be considered to help confirm the presence of drug-induced liver injury, if autoimmune hepatitis may be associated with the condition, and when immunosuppressive agents are being considered.

 Therapeutic aspects

Treatments for acute liver failure Acute liver failure treatments may include: Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose or mushroom poisoning is treated with drugs that can reverse the effects of the toxin and may reduce liver damage. Liver transplant. When acute liver failure can't be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes your damaged liver and replaces it with a healthy liver from a donor. Treatments for complications Control signs and symptoms you're experiencing and try to prevent complications caused by acute liver failure. This care may include: Relieving pressure caused by excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. 

 Statistics

The majority of liver transplantations were adult cadaveric transplantation. There is an increase in adult-adult living donation during the last decade (9%) compared with the previous decade (1.7%). Pediatric transplantations increased from 3.3% to 15%, while up to 30% are from living donors. Simultaneous liver-kidney transplantations (SLK) account for 6% of all transplantations, regardless of the change in the allocation scheme to the Model for End-Stage Liver Disease (MELD) score during 2005. The most common primary liver disease among liver transplant patients is hepatitis C virus (HCV) (34%) and the leading cause for liver transplantation since 2006 is hepatocellular carcinoma (31%). One year patient survival did not change significantly during two decades: 74.8 and 79.1%, respectively, although 5 years survival has increased during that period, from 54.9% to 67.3% (p = 0.05). Average annual mortality beyond the first year stands at 2.47%. The use of old donors (> 50) increased from 36.6% during 1991-1999 to 46% in the years 2005-2009.