INASL Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure

Abstract Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by anti-tuberculosis drugs induced hepatotoxicity are the commonest causes of ALF in India. Clinically such patients present with appearance of jaundice, encephalopathy and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF followed by superadded infections and determine the outcome in these patients. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a crucial role in the pathogenesis and several therapies aim to correct this abnormality. The role of newer ammonia lowering agents is still evolving. These patients are best managed at a tertiary care hospital with facility for liver transplantation. Aggressive intensive medical management has been documented to salvage a substantial proportion of patients. In those with poor prognostic factors, liver transplant is the only effective therapy that has been shown to imrove survival. However, recognizing suitable patients with poor prognosis has remained a challenge. Close monitoring, early identification and treatment of complications and couseling for transplant forms the first line approach to manage such patients. Recent research shows that use of dynamic prognostic models is better for selecting patients for liver transplantation and timely transplant can save life ALF patients with poor prognostic factors.