title: Current management of acute liver failure.
abstract: OBJECTIVE
  Acute liver failure (ALF) is a rare but life-threatening systemic disorder. Survival rates with or without emergency liver transplantation (ELT) are increasing. The benefit of ELT in some cases has been questioned and the potential for survival with medical management alone is changing our approach to the management of this disease.
  
  
  RESULTS
  Survival rates for all causes of ALF are increasing because of improvements in the care of the critically ill patient. A multifactorial approach involving support of respiratory, circulatory and renal function together with measures to avoid intracranial hypertension, metabolic disequilibrium and sepsis are required. For those who do not respond to these measures or specific antidotes, the selection methods for those likely to benefit from transplantation remain imperfect and novel methods based on the prediction of hepatic regeneration are required. For patients with ALF secondary to acetaminophen overdose, some experts believe a randomized controlled trial is required to find those most likely to benefit from ELT.
  
  
  CONCLUSIONS
  ALF remains a life-threatening condition with a high mortality rate requiring prompt support of multiorgan failure. Historical listing criteria for ELT are being questioned and improvement in medical management offers the option of continued improvements in transplant-free survival.
authors: Institute of Liver Studies, King's College Hospital, London, UK.
authors: Mark J W
authors: MJ
authors: McPhail
authors: Stephen
authors: S
authors: Kriese
authors: Michael A
authors: MA
authors: Heneghan
mesh_terms: D000082:Acetaminophen / Q000009:adverse effects*; D003422:Critical Care / Q000379:methods*; D062787:Drug Overdose / Q000401:mortality / Q000628:therapy*; D006501:Hepatic Encephalopathy / Q000401:mortality / Q000628:therapy*; D006801:Humans; D019586:Intracranial Hypertension / Q000401:mortality / Q000628:therapy*; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods / Q000639:trends; D011379:Prognosis; D018570:Risk Assessment
chemical_list: D000082:Acetaminophen