Acute liver failure: results of a 5-year clinical protocol.

M. Daas, D. J. Plevak, E. F. Wijdicks, Jorge Rakela, R. H. Wiesner, D. G. Piepgras, W. F. Dunn, J. L. Steers

Research output: Contribution to journalArticle

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Abstract

This investigation summarizes and evaluates the results of a clinical protocol that we designed to care for patients with acute liver failure (ALF). Adult patients with ALF were enrolled in the protocol. Grade II portal-systemic encephalopathy prompted admission to the intensive care unit (ICU). Patients who met the clinical criterion were activated for liver transplantation. Intracranial pressure (ICP) was monitored in patients with grade III encephalopathy. An increase in ICP was treated with hyperventilation, diuretics, barbiturates, or a combination thereof. Survival was considered to have occurred if the patient left the hospital alive. Our series included 25 patients. Orthotopic liver transplantation (OLT) was performed on 19 patients, 12 of whom survived. Only 2 of 6 patients who did not undergo transplantation survived. Ten of 11 patients who underwent transplantation before reaching grade IV encephalopathy survived. Only 2 of 8 patients who underwent transplantation after reaching grade IV survived (P = .006). The causes of death included cerebral edema (3 patients), disseminated aspergillosis (3 patients), and other (5 patients). ICP was monitored in 11 patients. Increased pressure was documented by seven of the monitors placed. There was one focal hemorrhage secondary to a subdural monitor. Outcome is improved if transplantation occurs before grade IV encephalopathy. ICP monitoring can be accomplished without significant risk of hemorrhage. In our series, infection with aspergillus occurred frequently and with fatal outcome.

Original languageEnglish (US)
Pages (from-to)210-219
Number of pages10
JournalLiver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
Volume1
Issue number4
StatePublished - Jul 1995

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Acute Liver Failure
Clinical Protocols
Intracranial Pressure
Brain Diseases
Transplantation
Liver Transplantation
Hemorrhage
Barbiturates
Intracranial Hypertension
Aspergillosis
Fatal Outcome
Hyperventilation
Hepatic Encephalopathy
Brain Edema
Aspergillus
Diuretics
Intensive Care Units
Cause of Death
Patient Care

ASJC Scopus subject areas

  • Hepatology
  • Surgery

Cite this

Acute liver failure : results of a 5-year clinical protocol. / Daas, M.; Plevak, D. J.; Wijdicks, E. F.; Rakela, Jorge; Wiesner, R. H.; Piepgras, D. G.; Dunn, W. F.; Steers, J. L.

In: Liver transplantation and surgery : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, Vol. 1, No. 4, 07.1995, p. 210-219.

Research output: Contribution to journalArticle

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