New Management Options for End-Stage Chronic Liver Disease and Acute Liver Failure

Definitions of acute liver failure Aetiology Presentation Investigation Initial management Subsequent management Markers of disease severity Paracetamol overdose Acute presentations of Wilson’s disease Acute-on-chronic liver failure Hepatic encephalopathy Criteria for emergency liver transplantation Acute liver failure (ALF) is defined as potentially reversible severe liver injury with impaired synthetic function (INR 〉1.5) and hepatic encephalopathy, developing within 28d from the onset of jaundice, in the absence of pre-existing liver disease or with well-compensated chronic liver disease (...

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Incidence of Bleeding and Thrombosis in Patients with Liver Disease

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0040-1714205 ◽

2020 ◽

Vol 46 (06) ◽

pp. 656-664 ◽

Cited By ~ 1

Author(s):

Lara N. Roberts ◽

William Bernal

Keyword(s):

Liver Transplantation ◽

Liver Disease ◽

Liver Failure ◽

Acute Liver Failure ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Bleeding Tendency ◽

Bleeding Events ◽

Targeted Treatments ◽

Coagulation Testing

AbstractHistorically, liver disease has been associated with a bleeding tendency. Global hemostatic assays have demonstrated that hemostasis is overall rebalanced, in both acute liver failure and chronic liver disease. It is now recognized that many bleeding events in chronic liver disease are mediated by portal hypertension rather than an underlying hemostatic defect. This is acknowledged in recent guidelines, which recommend against coagulation testing prior to low risk procedures in this patient group, with avoidance also of attempts at correction of prolonged coagulation times. Over time, the incidence of bleeding events has decreased in both chronic liver disease and acute liver failure, with improved supportive care, targeted treatments for underlying cause of liver disease, and the advent of liver transplantation. Concurrently, there has been increased recognition of the risk of thrombosis in chronic liver disease, with a predilection for the splanchnic vasculature. This review describes the incidence of bleeding and thrombosis in chronic liver disease and acute liver failure, including the periprocedural and liver transplantation setting.

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Evaluation of plasma ammonia levels in patients with acute liver failure and chronic liver disease and its correlation with the severity of hepatic encephalopathy and clinical features of raised intracranial tension

Clinical Biochemistry ◽

10.1016/j.clinbiochem.2005.04.013 ◽

2005 ◽

Vol 38 (8) ◽

pp. 696-699 ◽

Cited By ~ 67

Author(s):

Arun Kundra ◽

Anil Jain ◽

Alok Banga ◽

Girish Bajaj ◽

Premasish Kar

Keyword(s):

Liver Disease ◽

Hepatic Encephalopathy ◽

Liver Failure ◽

Acute Liver Failure ◽

Chronic Liver Disease ◽

Clinical Features ◽

Chronic Liver ◽

Plasma Ammonia

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Reply to Burdick: Constraining Physician Discretion

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100222135 ◽

2000 ◽

Vol 9 (2) ◽

pp. 280-283

Author(s):

Kenneth Einar Himma

Keyword(s):

Liver Disease ◽

Brain Death ◽

Liver Failure ◽

Acute Liver Failure ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Allocation Policy ◽

Liver Allocation ◽

Unos Policy

In “A Critique of UNOS Liver Allocation Policy,” I argued that the UNOS policy of placing acute liver failure patients (ALF patients) above chronic liver failure patients (CLF patients) on the transplant list fails to satisfy the principles of utility and justice that ostensibly guide UNOS allocation policy. Further, I argued that physician discretion in evaluating ALF and CLF patients should be expanded—not constrained. In response, Dr. Burdick attempts to justify the policy constraints on physician discretion on the strength of objective differences between ALF and CLF; as he puts it, “the distinction between acute liver failure and progression of chronic liver disease … is clear in the way brain death is.”

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Albumin in patients with liver disease shows an altered conformation

Communications Biology ◽

10.1038/s42003-021-02269-w ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Margret Paar ◽

Vera H. Fengler ◽

Daniel J. Rosenberg ◽

Angelika Krebs ◽

Rudolf E. Stauber ◽

...

Keyword(s):

Fatty Acids ◽

Liver Disease ◽

Chronic Liver Disease ◽

Chronic Liver ◽

X Ray Scattering ◽

Pathological Conditions ◽

Healthy Donors ◽

Relevant Variables ◽

End Stage

AbstractHuman serum albumin (HSA) constitutes the primary transporter of fatty acids, bilirubin, and other plasma compounds. The binding, transport, and release of its cargos strongly depend on albumin conformation, which is affected by bound ligands induced by physiological and pathological conditions. HSA is both highly oxidized and heavily loaded with fatty acids and bilirubin in chronic liver disease. By employing small-angle X-ray scattering we show that HSA from the plasma of chronic liver disease patients undergoes a distinct opening compared to healthy donors. The extent of HSA opening correlates with clinically relevant variables, such as the model of end-stage liver disease score, bilirubin, and fatty acid levels. Although the mild oxidation of HSA in vitro does not alter overall structure, the alteration of patients’ HSA correlates with its redox state. This study connects clinical data with structural visualization of albumin dynamicity in solution and underlines the functional importance of albumin’s inherent flexibility.

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