Acute liver failure

2018 ◽  
Vol 1 (1) ◽  
pp. 1-13
Author(s):  
Chalermrat Bunchorntavakul
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Intracranial Hypertension ◽  
Fungal Infections ◽  
Early Recognition ◽  
High Morbidity ◽  
Drug Induced ◽  
Liver Support ◽  
Term Survival ◽  
Extracorporeal Liver Support

Acute liver failure (ALF) is a life threatening condition defined by the evidence of hepatic injury, jaundice, coagulopathy, and encephalopathy in a patient without preexisting cirrhosis and with an illness duration of <26 weeks. The etiologies of ALF are heterogeneous: viral hepatitis being the most common in the East, whereas drug-induced, particularly acetaminophen, being the most common in the West. Over the past decades, the outcomes of ALF have been improving with early recognition and prompt initiation of etiology-specific therapy (especially N-acetylcysteine), complex intensive care protocols and urgent liver transplantation (LT). The most commonly used prognostic scoring systems include King’s College Criteria (more specific) and MELD (more sensitive). Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality in the early phase; hypertonic saline is suggested for patients with high-risk for developing intracranial hypertension (ICH) and when ICH develops, mannitol is recommended as first-line therapy. Bacterial and fungal infections are very common necessitating strict preventive measures, careful surveillance and prompt aggressive antimicrobial therapy. Acute kidney injury develops in 50-70% of patients; mostly reversible in survivors and temporary dialysis is required in about 30% of cases. Overall 1-year survival after LT has been reported to be lower in patients with ALF as compared to those with cirrhosis; however following the first year this trend has been to be reversed and ALF patients have a better long-term survival. Extracorporeal liver support system, such as albumin dialysis and plasmapheresis, may serve as a bridge to LT and may increase LT-free survival in select cases.

Acute liver failure

2018 ◽  
Vol 1 (1) ◽  
pp. 1-13
Author(s):  
Chalermrat Bunchorntavakul
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Intracranial Hypertension ◽  
Cerebral Edema ◽  
Fungal Infections ◽  
Early Recognition ◽  
High Morbidity ◽  
Term Survival ◽  
Extracorporeal Liver Support ◽  
Ct Brain

Acute liver failure (ALF) is a life threatening condition defined by the evidence of hepatic injury, jaundice, coagulopathy, and encephalopathy in a patient without preexisting cirrhosis and with an illness duration of <26 weeks. The etiologies of ALF are heterogeneous: viral hepatitis being the most common in the East, whereas drug-induced, particularly acetaminophen, being the most common in the West. Over the past decades, the outcomes of ALF have been improving with early recognition and prompt initiation of etiology-specific therapy (especially N-acetylcysteine), complex intensive care protocols and urgent liver transplantation (LT). The most commonly used prognostic scoring systems include King’s College Criteria (more specific) and MELD (more sensitive). Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality in the early phase; hypertonic saline is suggested for patients with high-risk for developing intracranial hypertension (ICH) and when ICH develops, mannitol is recommended as first-line therapy. Bacterial and fungal infections are very common necessitating strict preventive measures, careful surveillance and prompt aggressive antimicrobial therapy. Acute kidney injury develops in 50-70% of patients; mostly reversible in survivors and temporary dialysis is required in about 30% of cases. Overall 1-year survival after LT has been reported to be lower in patients with ALF as compared to those with cirrhosis; however following the first year this trend has been to be reversed and ALF patients have a better long-term survival. Extracorporeal liver support system, such as albumin dialysis and plasmapheresis, may serve as a bridge to LT and may increase LT-free survival in select cases. Figure 1 CT brain ของผู้ป่วยเพศหญิง อายุ 22 ปี มีภาวะตับวายเฉียบพลันจากยา แรกรับมี encephalopathy grade III CT brain พบ mild cerebral edema with loss of sulciand gyri, blurring of grey - white junctions and mild narrowing of entricles (A) 3 วันหลังเข้ารับการรักษาในโรงพยาบาล ผู้ป่วยมีอาการแย่ลง encephalopathy grade IV, sluggish pupillary response to light botheyes: CT brain พบ progression of cerebral edema, loss of grey-white junctions and brain herniation (B)

Acute liver failure

2018 ◽  
Vol 1 (1) ◽  
pp. 1-13
Author(s):  
Chalermrat l Bunchorntavaku
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Intracranial Hypertension ◽  
Cerebral Edema ◽  
Fungal Infections ◽  
Early Recognition ◽  
High Morbidity ◽  
Term Survival ◽  
Extracorporeal Liver Support ◽  
Ct Brain

Acute liver failure (ALF) is a life threatening condition defined by the evidence of hepatic injury, jaundice, coagulopathy, and encephalopathy in a patient without preexisting cirrhosis and with an illness duration of <26 weeks. The etiologies of ALF are heterogeneous: viral hepatitis being the most common in the East, whereas drug-induced, particularly acetaminophen, being the most common in the West. Over the past decades, the outcomes of ALF have been improving with early recognition and prompt initiation of etiology-specific therapy (especially N-acetylcysteine), complex intensive care protocols and urgent liver transplantation (LT). The most commonly used prognostic scoring systems include King’s College Criteria (more specific) and MELD (more sensitive). Cerebral edema and intracranial hypertension are reasons for high morbidity and mortality in the early phase; hypertonic saline is suggested for patients with high-risk for developing intracranial hypertension (ICH) and when ICH develops, mannitol is recommended as first-line therapy. Bacterial and fungal infections are very common necessitating strict preventive measures, careful surveillance and prompt aggressive antimicrobial therapy. Acute kidney injury develops in 50-70% of patients; mostly reversible in survivors and temporary dialysis is required in about 30% of cases. Overall 1-year survival after LT has been reported to be lower in patients with ALF as compared to those with cirrhosis; however following the first year this trend has been to be reversed and ALF patients have a better long-term survival. Extracorporeal liver support system, such as albumin dialysis and plasmapheresis, may serve as a bridge to LT and may increase LT-free survival in select cases. Figure 1 CT brain ของผู้ป่วยเพศหญิง อายุ 22 ปี มีภาวะ ตับวายเฉียบพลันจากยา แรกรับมี encephalopathy grade III CT brain พบ mild cerebral edema with loss of sulci and gyri, blurring of grey - white junctions and mild narrowing of ventricles (A) 3 วันหลังเข้ารับการรักษา ในโรงพยาบาล ผู้ป่วยมีอาการแย่ลง encephalopathy grade IV, sluggish pupillary response to light both eyes: CT brain พบ progression of cerebral edema, loss of grey-white junctions and brain herniation (B)

scholarly journals Therapeutic plasma exchange in children with acute liver failure (ALF): is it time for incorporation into the ALF armamentarium?

2021 ◽  
Author(s):  
Emma C. Alexander ◽  
Akash Deep
Keyword(s):  
Liver Failure ◽  
Acute Liver Failure ◽  
Plasma Exchange ◽  
Controlled Trial ◽  
High Volume ◽  
Systemic Circulation ◽  
Liver Support ◽  
Extracorporeal Liver Support ◽  
Randomised Controlled ◽  
Liver Assist Devices

AbstractPaediatric acute liver failure (PALF) is a rare but devastating condition with high mortality. An exaggerated inflammatory response is now recognised as pivotal in the pathogenesis and prognosis of ALF, with cytokine spill from the liver to systemic circulation implicated in development of multi-organ failure associated with ALF. With advances in medical management, especially critical care, there is an increasing trend towards spontaneous liver regeneration, averting the need for emergency liver transplantation or providing stability to the patient awaiting a graft. Hence, research is ongoing for therapies, including extracorporeal liver support devices, that can bridge patients to transplant or spontaneous liver recovery. Considering the immune-related pathogenesis and inflammatory phenotype of ALF, plasma exchange serves as an ideal liver assist device as it performs both the excretory and synthetic functions of the liver and, in addition, works as an immunomodulatory therapy by suppressing the early innate immune response in ALF. After a recent randomised controlled trial in adults demonstrated a beneficial effect of high-volume plasma exchange on clinical outcomes, this therapy was incorporated in European Association for the Study of Liver (EASL) recommendations for managing adult patients with ALF, but no guidelines exist for PALF. In this review, we discuss rationale, timing, practicalities, and existing evidence regarding the use of plasma exchange as an immunomodulatory treatment in PALF. We discuss controversies in delivery of this therapy as an extracorporeal device, and practicalities of use of plasma exchange as a ‘hybrid’ therapy alongside other extracorporeal liver assist devices, before finally reviewing outstanding research questions for the future.

scholarly journals Applying the Molecular Adsorbent Recirculating System (MARS) in the Treatment of Acute Liver Failure (ALF) Case Report

2018 ◽  
Vol 19 (2) ◽  
pp. 189-194
Author(s):  
Jagoda Gavrilovic ◽  
Jelena Djordjevic Velickovic ◽  
Zeljko Mijailovic ◽  
Tatjana Lazarevic ◽  
Aleksandar Gavrilovic ◽  
...  
Keyword(s):  
Hepatic Encephalopathy ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Clinical Signs ◽  
Caucasian Woman ◽  
Coagulation Disorder ◽  
Liver Support ◽  
Molecular Adsorbent Recirculating System ◽  
Extracorporeal Liver Support ◽  
Molecular Adsorbent

Abstract Acute liver failure (ALF) is a rare but life-threatening illness with multiple organ failure. The short-term mortality rate exceeded 80 % despite modern approaches in treatment. Drugs, infections by hepatic viruses and toxins are the most common causes of ALF. Progressive jaundice, coagulation disorder and hepatic encephalopathy are dominated as a clinical signs of the illness. We present a case of a 36-year-old Caucasian woman hospitalized in ICU due to yellow discoloration of the skin and sclera, severe disseminated coagulopathy and hemodynamic instability. ALF is developed due to Hepatitis B Virus infection, resulting in hepatic toxicity as well as coma. General condition rapidly improved after applying of Molecular Adsorbent Recirculating System (MARS), an extracorporeal liver support system based on albumin dialysis. It is relatively expensive treatment that is used for the patient with hepatic encephalopathy grade 3 or 4 in our institution. In conclusion, an early administration of MARS significantly reveals subjective and objective clinical improvement in the case we presented.

Acute Liver Failure

2018 ◽  
Author(s):  
Constantine J Karvellas ◽  
R. Todd Stravitz
Keyword(s):  
Liver Transplantation ◽  
Liver Failure ◽  
Acute Liver Failure ◽  
Intracranial Hypertension ◽  
Cerebral Edema ◽  
High Volume ◽  
Important Lesson ◽  
Drug Induced ◽  
Systemic Complications ◽  
Developed Nations

Acute liver failure (ALF) remains one of the most dramatic and highly mortal syndromes in modern medicine, with a poor outcome (death or need for emergency liver transplantation) in more than 50% of affected patients. However, prevention of specific etiologies of ALF, general improvements in intensive care medicine, and specific improvements in the management of the systemic complications of ALF, have markedly reduced mortality over the last 40 years. Specific ALF etiologies, including hepatitis A and B, appear to have decreased in developed nations along with improvements in sanitation and widespread vaccination. The management of specific complications—cerebral edema in particular—has lowered the proportion of ALF deaths due to intracranial hypertension, which was once the most dreaded systemic manifestation of ALF. A recent randomized, multicenter trial has documented the efficacy of high-volume plasma exchange in improving transplant-free and overall in-hospital survival. These and other advances have led to a speculation that ALF will be a “curable” clinical condition by the year 2024. Challenges persist, however, as acetaminophen (APAP) overdose continues to account for ~50% of cases of ALF in many developed nations. In the United Kingdom, legislation to limit access to the drug has led to a marked decrease in the incidence of ALF due to acetaminophen overdose: an important lesson for other governments to consider as they work to meet the goal of rendering ALF a “curable” condition.   This review contains 6 figures, 10 tables and 53 references Key Words: acetaminophen, acute liver failure, cerebral edema, drug-induced liver injury, extracorporeal liver assist device, fulminant liver failure, hepatic encephalopathy, intracranial hypertension, liver transplantation

scholarly journals Extracorporeal liver support devices in the ICU

2016 ◽  
Author(s):  
Rajiv Jalan ◽  
Banwari Agarwal
Keyword(s):  
Liver Failure ◽  
Definitive Treatment ◽  
Current Evidence ◽  
High Morbidity ◽  
Liver Support ◽  
Transporter Protein ◽  
Extracorporeal Liver Support ◽  
Mechanical Devices ◽  
Liver Support Devices ◽  
Support Devices

Liver failure is common and carries high morbidity and mortality. Liver transplantation (LT) is the only definitive treatment available performed as an emergency in acute liver failure and electively for chronic liver disease. In the last 50 years, a number of extracorporeal liver support devices and modifications have emerged , some of them purely mechanical in nature aimed at detoxification, while others are cell based systems possessing bio-transformational capability. Mechanical devices are mainly based on albumin dialysis, albumin being a key transporter protein that is severely deficient and irreversibly destroyed in liver diseases. Despite a sound scientific rationale and good safety profile, none of the currently available devices have shown enough promise to be incorporated in routine clinical practice, their use being limited to specific clinical situations. This chapter describes currently available devices, their operational characteristics, current evidence of their utility and limitation, and the future developments in the field of extracorporeal liver support.

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