Acute liver failure: An up-to-date approach

Abstract

a b s t r a c t a r t i c l e i n f oAcute liver failure is a rare but potentially devastating disease. Throughout the last few decades, acute liver failure outcomes have been improving in the context of the optimized overall management. This positive trend has been associated with the earlier recognition of this condition, the improvement of the intensive care unit management, and the developments in emergent liver transplantation. Accordingly, we aimed to review the current diagnostic and therapeutic approach to this syndrome, especially in the intensive care unit setting.

Epidemiology of Acute Liver Failure from a Regional Liver Transplant Center in Portugal

“…Nevertheless, the mortality amongst the transplant-free patients in our cohort (73%) was greater than in the German cohort (35%). This difference may to some extent be related to the fact that the following ALF severity markers were more frequently worse in our cohort than in the German one: median age (49 vs. 46 years), INR (3.0 vs. 2.5), creatinine (1.4 vs. 1.0 mg/dL) and lactate (3.3 vs. 3.0 mmol/L) levels, and the proportion of patients fulfilling the KCC on ICU admission (47 vs. 37%) [1]. However, we need to improve the diagnostic and treatment strategies for patients with non-paracetamol-related ALF without LT.…”

“…Acute liver failure (ALF) is a rare life-threatening disease characterized by recent deterioration of liver function associated with coagulopathy and hepatic encephalopathy (HE) without evidence of cirrhosis [1, 2]. In the absence of HE, this type of liver dysfunction is often defined as acute liver injury (ALI).…”

“…The incidence of ALF in Europe has been reported as fewer than 10 cases per million people per year in developed countries [1]. Based on the European Liver Transplant Registry, ALF has been the primary indication in 8% of all liver transplant (LT) procedures undergone between 1988 and 2009: 21% of them were due to viral infection, 21% due to drug-induced liver injury (11% by paracetamol and 10% by other drugs), and 58% due to other causes or unknown etiology [2].…”

Beneficial Effects of Human Mesenchymal Stromal Cells on Porcine Hepatocyte Viability and Albumin Secretion

“…Liver transplantation, which has to occur in the few days following liver destruction, remains the only treatment with lifelong immunosuppression thereafter [1]. Additionally, the availability of an adequate human liver is not guaranteed, demonstrating the need for new therapeutic options.…”

“…Nuclear magnetic resonance (NMR) spectra were recorded on Bruker Avance III-400, Bruker Avance-400, or Bruker DRX-400 spectrometers at room temperature (rt) (400 MHz) (Bruker, Billerica, MA, USA). 1 H frequency is at 400.13 MHz. Chemical shifts are expressed in parts per million (ppm) and coupling constants (J) in hertz (Hz).…”