A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure

Ozturk, Nazli Begum; Herdan, Emre; Saner, Fuat H.; Gurakar, Ahmet

doi:10.3390/jcm12237451

Cited by 6 publications

(3 citation statements)

References 57 publications

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“…In contrast to acute single ingestion, subacute or chronic toxicity emerges from the cumulative effect of multiple doses of acetaminophen over time, surpassing recommended limits [8]. With repeated use, there is an inherent risk of gradual metabolite accumulation, particularly the toxic NAPQI, within the liver [10].…”

Section: Subacute or Chronic Toxicity Resulting From Multiple Acetami...mentioning

confidence: 99%

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A Clinical Course of Repeated Supratherapeutic Ingestion of Acetaminophen

Shah,

Campbell,

Patel

et al. 2024

Cureus

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Acute liver failure (ALF) exemplifies a rapid decline in liver function among individuals with previously healthy livers, often manifesting through symptoms such as jaundice, confusion, and potentially lifethreatening complications. Timely medical intervention, and, in severe instances, liver transplantation, are essential for enhancing outcomes and averting further deterioration. While the causes of ALF are multifaceted, in developed nations, it predominantly arises from drug-induced liver injury. Treatment primarily revolves around supportive measures, with severe cases necessitating liver transplantation. In instances where acute overdose with acetaminophen serves as the instigating factor, N-acetylcysteine (NAC) emerges as a pivotal component of management, as indicated by the Rumack-Matthew nomogram. The Rumack-Matthew nomogram guides treatment for acetaminophen overdose by correlating serum levels with the risk of liver damage. If levels exceed a set threshold, NAC is administered to prevent toxicity by replenishing glutathione. The decision to administer NAC is typically guided by this clinical tool, which aids healthcare providers in determining the appropriate course of action. NAC assumes a critical role in ameliorating the detrimental effects of acetaminophen overdose, particularly in averting liver damage, thus holding significant importance in patient care and recovery. While chronic acetaminophen overdose cases leading to ALF may also benefit from NAC, the supporting evidence remains weak. In this context, we present a case of ALF stemming from chronic acetaminophen ingestion, managed with NAC when liver transplantation was not a viable option.

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Section: Subacute or Chronic Toxicity Resulting From Multiple Acetami...mentioning

confidence: 99%

“…The toxic mechanism involves an overwhelming of the liver's detoxification capacity, resulting in hepatocellular necrosis [10]. The severity of liver damage correlates directly with the ingested dose, and an acute overdose can swiftly progress to fulminant hepatic failure [7].…”

Section: Immediate Effects Of Acute Acetaminophen Toxicitymentioning

confidence: 99%

A Clinical Course of Repeated Supratherapeutic Ingestion of Acetaminophen

Shah,

Campbell,

Patel

et al. 2024

Cureus

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“…The first successful liver transplantation (LT) was performed in 1967 by Dr. Thomas Starzl, with a congressional hearing approving LT for general use in 1983 [1]. LT is currently employed as a life-saving measure for multiple indications, including chronic liver disease, hepatocellular carcinoma (HCC), and acute liver failure [2,3]. In 2021, 34,694 LTs were performed globally, a 6.5% increase from 2020 and 20% increase from 2015 [2].…”

Section: Introductionmentioning

confidence: 99%

Approach to Liver Transplantation: Is There a Difference between East and West?

Ozturk,

Bartosek,

Toruner

et al. 2024

JCM

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Liver transplantation (LT) remains the only curative treatment for end-stage liver disease as well as acute liver failure. With the exponential increase in organ demand due to the increasing incidence and prevalence of liver diseases, the need to overcome the supply and demand mismatch has arisen. In this review, we discuss the current universal status of LT, emphasizing various LT practices worldwide.

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An international, multicenter, survey-based analysis of practice and management of acute liver failure

Gurakar,

Conde Amiel,

Ozturk

et al. 2024

Liver Transplantation

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Introduction: Acute liver failure (ALF) is an acute liver dysfunction with coagulopathy and hepatic encephalopathy in a patient with no known liver disease. As ALF is rare and large clinical trials are lacking, the level of evidence regarding its management is low-moderate, favoring heterogeneous clinical practice. In this international multicenter survey study, we aimed to investigate the current practice and management of patients with ALF. Methods: An online survey targeting physicians who care for patients with ALF was developed by the International Liver Transplantation Society ALF Special-Interest Group. The survey focused on management and liver transplantation (LT) practices of ALF. Survey questions were summarized overall and by geographic region. Results: A total of 267 physicians completed the survey with a survey response rate of 21.36%. Centers from all continents were represented. More than 90% of physicians were specialized in either transplant hepatology/surgery or anesthesiology/critical care. Two hundred and fifty-two (94.4%) respondents’ institutions offered LT. A total of 76.8% of respondents’ centers had a dedicated liver- or transplant- intensive care unit (p<0.001). Median time to LT was within 48 hours in 12.7% of respondents’ centers, 72 hours in 35.6%, one week in 37.6%, and more than one week in 9.6% (p<0.001). Deceased-donor liver graft (49.6%) was the most common type of graft offered. For consideration of LT, 84.8% of physicians used King’s College Criteria and 41.6% used Clichy Criteria. Significant differences were observed between Asia, Europe, and North America for offering LT, number of LTs performed, volume of ALF patients, admission to a dedicated intensive care unit, median time to LT, type of liver graft, monitoring hepatic encephalopathy and intracranial pressure, management of coagulopathy, and utilization of different criteria for LT. Discussion: In our study, we observed significant geographic differences in the practice and management of ALF. As ALF is rare multicenter studies are valuable to identify global practice.

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A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure

Cited by 6 publications

References 57 publications

A Clinical Course of Repeated Supratherapeutic Ingestion of Acetaminophen

A Clinical Course of Repeated Supratherapeutic Ingestion of Acetaminophen

Approach to Liver Transplantation: Is There a Difference between East and West?

An international, multicenter, survey-based analysis of practice and management of acute liver failure

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