Etiology and outcome of acute liver failure: experience from a liver transplantation centre in Montreal.
BACKGROUND
Acute liver failure is a rare condition in which massive liver injury is associated with the rapid development of hepatic encephalopathy. Although viral hepatitis and drug-induced liver injury are the most common causes, no specific etiology is found in a substantial proportion of cases reported from Europe and the United States.


OBJECTIVE
To determine the etiology and outcome of patients with acute liver failure in the authors' institution.


METHODS
The charts of 81 consecutive patients admitted to Saint-Luc between 1991 and 1999 were reviewed.


RESULTS
The etiology was viral in 27 cases (33.2%), toxic or drug-induced in 22 (27.2%), of unknown origin in 22 (27.2%) and due to various causes in 10 (12.3%) (autoimmune, vascular, cancer). Of the 81 patients, 16% survived without liver transplantation, and 84% died or underwent liver transplantation. Survival without liver transplantation differed according to the mode of presentation: the survival rate was 27% in patients with hyperacute liver failure, 7% in those with acute liver failure and 0% in those with subacute liver failure. Among the 38 patients who underwent liver transplantation, survival one year after transplantation was 71%. In the 30 patients who died without liver transplantation, the main causes of death were cerebral edema and sepsis.


CONCLUSIONS
Acute liver failure is associated with a high mortality, and liver transplantation is the treatment of choice. In a significant proportion of cases, the etiology remains undetermined and is probably related to yet unidentified hepatotropic viruses.
Tessier
Geneviève
G
Division of Hepatology, Hôpital Saint-Luc, Centre Hospitalier de l'Université de Montréal, Montréal, Canada.
Villeneuve
Edith
E
Villeneuve
Jean-Pierre
JP
D000328:Adult; D017677:Age Distribution; D000368:Aged; D002423:Cause of Death; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006757:Hospital Units; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality; D011792:Quebec; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate