Acute liver failure

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Abstract
Acute liver failure is a rare but potentially devastating illness characterized by a rapid onset of coagulopathy and encephalopathy. The observation that chronic hepatitis occurs more frequently in patients with acute liver failure of indeterminate cause than in patients with identified causes suggests that a transmissible agent may be involved in some cases. However, virologic studies reveal that seronegative hepatitis B virus or herpesvirus infection account for only a minority of cases of acute liver failure of indeterminate cause. Acetaminophen hepa-totoxicity has recently become identified as a leading cause of acute liver failure in the United States, Wherase Bacillus cereus toxin ingestion and a host of idiosyncratic drug reactions were added to the long list of other less common causes. The “ligand-stabilizing‘’ effect of ethanol on CYP2E1 enzyme activity may in part explain the increasingly reported association between alcohol ingestion and surreptitious acetaminophen hepatotoxicity. Advances in the treatment of acute liver failure include the development of noninvasive techniques to monitor cerebral blood flow and oxygen consumption. Favorable experience with bioartificial liver devices continue to be resported, but concerns of immunologic and infectious complications arising from the use of porcine organs have been raised. Exciting pilot work involving isolated hepatocyte transplantation in animal models and in small series of patients continues to provide hope for more elegant treatments of acute liver failur short of emergency liver transplantation, which remains a proven but expensive life-saving intervention.

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