title: Etiology and outcome of acute liver failure: retrospective analysis of 50 patients treated at a single center.
abstract: OBJECTIVE
  Acute liver failure (ALF) remains a devastating disease carrying considerable mortality. Since deceased donor liver transplantation is rarely performed in Japan, the artificial liver support system (ALS) and living donor liver transplantation (LDLT) are the main modalities used for treatment of ALF. The aim of this study was to analyze the outcome of ALF patients and to evaluate therapies for ALF according to etiology.
  
  
  METHODS
  Fifty consecutive patients with ALF were treated between January 1990 and December 2006. Prior to 1997, patients received ALS only. After 1997, ALS and/or LDLT were applied. LDLT was performed in 10 patients.
  
  
  RESULTS
  Four of 15 (27%) pre-1997 ALF patients survived, and 16 of 35 (46%) post-1997 ALF patients survived, including eight who underwent LDLT. The causes of ALF were acute hepatitis B virus (HBV) infection in 18%, severe acute exacerbation (SAE) of chronic HBV infection in 18%, autoimmune hepatitis (AIH) in 8%, and cryptogenic hepatitis in 44%. In total, 67% of the patients with ALF caused by acute HBV infection and AIH were cured without LDLT; only 11% of patients with ALF caused by SAE of HBV and 24% of cryptogenic hepatitis were successfully treated without LDLT. Notably, 80% of patients with cryptogenic hepatitis who underwent LDLT survived.
  
  
  CONCLUSIONS
  Since 1997, the survival rate of ALF patients has increased, mainly due to the introduction of LDLT. Liver transplantation should be performed especially in patients with ALF caused by SAE of HBV and cryptogenic hepatitis.
authors.affiliation: Department of Medicine and Molecular Science, Hiroshima University, Hiroshima, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Hiramatsu
authors.forename: Shoichi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikata
authors.forename: Takahiro
authors.initials: T
authors.lastname: Azakami
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Katamura
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kawaoka
authors.forename: Kiminori
authors.initials: K
authors.lastname: Uka
authors.forename: Keitaro
authors.initials: K
authors.lastname: Yamashina
authors.forename: Shintaro
authors.initials: S
authors.lastname: Takaki
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kodama
authors.forename: Soo Cheol
authors.initials: SC
authors.lastname: Jeong
authors.forename: Michio
authors.initials: M
authors.lastname: Imamura
authors.forename: Yoshiiku
authors.initials: Y
authors.lastname: Kawakami
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Chayama
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology* / Q000628:therapy*; D016031:Liver Transplantation; D019164:Liver, Artificial; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome