Acute liver failure

Summary of a workshop

William M. Lee, Robert H. Squires, Scott Nyberg, Edward Doo, Jay H. Hoofnagle

Research output: Contribution to journalArticle

446 Citations (Scopus)

Abstract

Acute liver failure (ALF) is a rare but challenging clinical syndrome with multiple causes; a specific etiology cannot be identified in 15% of adult and 50% of pediatric cases. The course of ALF is variable and the mortality rate is high. Liver transplantation is the only therapy of proven benefit, but the rapidity of progression and the variable course of ALF limit its use. Currently in the United States, spontaneous survival occurs in approximately 45%, liver transplantation in 25%, and death without transplantation in 30% of adults with ALF. Higher rates of spontaneous recovery (56%) and transplantation (31%) with lower rates of death (13%) occur in children. The outcome of ALF varies by etiology, favorable prognoses being found with acetaminophen overdose, hepatitis A, and ischemia (≈60% spontaneous survival), and poor prognoses with drug-induced ALF, hepatitis B, and indeterminate cases (≈=25% spontaneous survival). Excellent intensive care is critical in management of patients with ALF. Nonspecific therapies are of unproven benefit. Future possible therapeutic approaches include N-acetylcysteine, hypothermia, liver assist devices, and hepatocyte transplantation. Advances in stem cell research may allow provision of cells for bioartificial liver support. ALF presents many challenging opportunities in both clinical and basic research.

Original languageEnglish (US)
Pages (from-to)1401-1415
Number of pages15
JournalHepatology
Volume47
Issue number4
DOIs
StatePublished - Apr 1 2008

Fingerprint

Acute Liver Failure
Education
Transplantation
Liver Transplantation
Survival
Artificial Liver
Stem Cell Research
Hepatitis A
Mortality
Acetylcysteine
Critical Care
Acetaminophen
Hypothermia
Hepatitis B
Hepatocytes
Therapeutics
Ischemia
Pediatrics
Equipment and Supplies
Liver

ASJC Scopus subject areas

  • Hepatology

Cite this

Lee, W. M., Squires, R. H., Nyberg, S., Doo, E., & Hoofnagle, J. H. (2008). Acute liver failure: Summary of a workshop. Hepatology, 47(4), 1401-1415. https://doi.org/10.1002/hep.22177

Acute liver failure : Summary of a workshop. / Lee, William M.; Squires, Robert H.; Nyberg, Scott; Doo, Edward; Hoofnagle, Jay H.

In: Hepatology, Vol. 47, No. 4, 01.04.2008, p. 1401-1415.

Research output: Contribution to journalArticle

Lee, WM, Squires, RH, Nyberg, S, Doo, E & Hoofnagle, JH 2008, 'Acute liver failure: Summary of a workshop', Hepatology, vol. 47, no. 4, pp. 1401-1415. https://doi.org/10.1002/hep.22177
Lee WM, Squires RH, Nyberg S, Doo E, Hoofnagle JH. Acute liver failure: Summary of a workshop. Hepatology. 2008 Apr 1;47(4):1401-1415. https://doi.org/10.1002/hep.22177
Lee, William M. ; Squires, Robert H. ; Nyberg, Scott ; Doo, Edward ; Hoofnagle, Jay H. / Acute liver failure : Summary of a workshop. In: Hepatology. 2008 ; Vol. 47, No. 4. pp. 1401-1415.
@article{c2072ecf55334deb97e4c98a9bbabcb2,
title = "Acute liver failure: Summary of a workshop",
abstract = "Acute liver failure (ALF) is a rare but challenging clinical syndrome with multiple causes; a specific etiology cannot be identified in 15{\%} of adult and 50{\%} of pediatric cases. The course of ALF is variable and the mortality rate is high. Liver transplantation is the only therapy of proven benefit, but the rapidity of progression and the variable course of ALF limit its use. Currently in the United States, spontaneous survival occurs in approximately 45{\%}, liver transplantation in 25{\%}, and death without transplantation in 30{\%} of adults with ALF. Higher rates of spontaneous recovery (56{\%}) and transplantation (31{\%}) with lower rates of death (13{\%}) occur in children. The outcome of ALF varies by etiology, favorable prognoses being found with acetaminophen overdose, hepatitis A, and ischemia (≈60{\%} spontaneous survival), and poor prognoses with drug-induced ALF, hepatitis B, and indeterminate cases (≈=25{\%} spontaneous survival). Excellent intensive care is critical in management of patients with ALF. Nonspecific therapies are of unproven benefit. Future possible therapeutic approaches include N-acetylcysteine, hypothermia, liver assist devices, and hepatocyte transplantation. Advances in stem cell research may allow provision of cells for bioartificial liver support. ALF presents many challenging opportunities in both clinical and basic research.",
author = "Lee, {William M.} and Squires, {Robert H.} and Scott Nyberg and Edward Doo and Hoofnagle, {Jay H.}",
year = "2008",
month = "4",
day = "1",
doi = "10.1002/hep.22177",
language = "English (US)",
volume = "47",
pages = "1401--1415",
journal = "Hepatology",
issn = "0270-9139",
publisher = "John Wiley and Sons Ltd",
number = "4",

}

TY - JOUR

T1 - Acute liver failure

T2 - Summary of a workshop

AU - Lee, William M.

AU - Squires, Robert H.

AU - Nyberg, Scott

AU - Doo, Edward

AU - Hoofnagle, Jay H.

PY - 2008/4/1

Y1 - 2008/4/1

N2 - Acute liver failure (ALF) is a rare but challenging clinical syndrome with multiple causes; a specific etiology cannot be identified in 15% of adult and 50% of pediatric cases. The course of ALF is variable and the mortality rate is high. Liver transplantation is the only therapy of proven benefit, but the rapidity of progression and the variable course of ALF limit its use. Currently in the United States, spontaneous survival occurs in approximately 45%, liver transplantation in 25%, and death without transplantation in 30% of adults with ALF. Higher rates of spontaneous recovery (56%) and transplantation (31%) with lower rates of death (13%) occur in children. The outcome of ALF varies by etiology, favorable prognoses being found with acetaminophen overdose, hepatitis A, and ischemia (≈60% spontaneous survival), and poor prognoses with drug-induced ALF, hepatitis B, and indeterminate cases (≈=25% spontaneous survival). Excellent intensive care is critical in management of patients with ALF. Nonspecific therapies are of unproven benefit. Future possible therapeutic approaches include N-acetylcysteine, hypothermia, liver assist devices, and hepatocyte transplantation. Advances in stem cell research may allow provision of cells for bioartificial liver support. ALF presents many challenging opportunities in both clinical and basic research.

AB - Acute liver failure (ALF) is a rare but challenging clinical syndrome with multiple causes; a specific etiology cannot be identified in 15% of adult and 50% of pediatric cases. The course of ALF is variable and the mortality rate is high. Liver transplantation is the only therapy of proven benefit, but the rapidity of progression and the variable course of ALF limit its use. Currently in the United States, spontaneous survival occurs in approximately 45%, liver transplantation in 25%, and death without transplantation in 30% of adults with ALF. Higher rates of spontaneous recovery (56%) and transplantation (31%) with lower rates of death (13%) occur in children. The outcome of ALF varies by etiology, favorable prognoses being found with acetaminophen overdose, hepatitis A, and ischemia (≈60% spontaneous survival), and poor prognoses with drug-induced ALF, hepatitis B, and indeterminate cases (≈=25% spontaneous survival). Excellent intensive care is critical in management of patients with ALF. Nonspecific therapies are of unproven benefit. Future possible therapeutic approaches include N-acetylcysteine, hypothermia, liver assist devices, and hepatocyte transplantation. Advances in stem cell research may allow provision of cells for bioartificial liver support. ALF presents many challenging opportunities in both clinical and basic research.

UR - http://www.scopus.com/inward/record.url?scp=42249102412&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=42249102412&partnerID=8YFLogxK

U2 - 10.1002/hep.22177

DO - 10.1002/hep.22177

M3 - Article

VL - 47

SP - 1401

EP - 1415

JO - Hepatology

JF - Hepatology

SN - 0270-9139

IS - 4

ER -