Continuing Education in Anaesthesia Critical Care and Pain | Volume 4 Number 2 | 2004
© The Board of Management and Trustees of the British Journal of Anaesthesia 2004
Management of acute liver failure
Liver Laboratories, University of Birmingham, Birmingham
Queen Elizabeth Hospital, Birmingham, B15 2TH
Tel: 0121 472 1311, Fax: 0121 627 2497, E-mail: nick.murphy{at}uhb.nhs.uk (for correspondence)
Acute liver failure (ALF) is a devastating syndrome that triggers a cascade of events, leading to multiple organ failure and often death. A previously normal liver may fail within days or weeks; and despite recent advances in intensive care and organ support, mortality rates remain high. In those patients with high grades of encephalopathy, the chances of survival are less than 20% with medical management alone. Early deaths in ALF are often caused by cerebral oedema or cardiovascular collapse, whereas late deaths tend to result from sepsis and multiple organ failure. Liver transplantation is the only current definitive treatment in those failing supportive medical management. However, hepatic assist devices are currently under investigation to provide liver support as a ‘bridge to transplantation’ or during recovery of the native liver.