Acute liver failure: A curable disease by 2024?
Over the last three decades acute liver failure (ALF) has been transformed from a rare and poorly understood condition with a near universally fatal outcome, to one with a well characterized phenotype and disease course. Complex critical care protocols are now applied and emergency liver transplantation (ELT) is an established treatment option. These improvements in care are such that the majority of patients may now be expected to survive (Fig. 1). Key features of the condition have changed dramatically over time, with a remarkable fall in the incidence of cerebral edema and intracranial hypertension, a much feared complication. In this review, we summarize the current understanding of key aspects of the classification, pathophysiology and management of ALF, and discuss the foreseeable challenges that will need to be addressed for further improvements to be achieved.
Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom. Electronic address: william.bernal@kcl.ac.uk.
William
W
Bernal
Division of Digestive and Liver Diseases, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-8887, USA.
William M
WM
Lee
Liver Intensive Therapy Unit, Institute of Liver Studies, Kings College Hospital, Denmark Hill, London SE5 9RS, United Kingdom.
Julia
J
Wendon
Department of Hepatology, Rigshospitalet, 2100 Copenhagen, Denmark.
Fin Stolze
FS
Larsen
Institute of Hepatology London, Foundation for Liver Research, 69-75 Chenies Mews, London WC1 6HX, United Kingdom.
Roger
R
Williams
D001812:Blood-Brain Barrier; D001929:Brain Edema / Q000209:etiology; D006501:Hepatic Encephalopathy / Q000209:etiology; D006801:Humans; D017114:Liver Failure, Acute / Q000209:etiology / Q000628:therapy*; D016031:Liver Transplantation; D011379:Prognosis
Acute liver failure; Ammonia; Cerebral edema; Transplantation