Acute hepatic failure: A Western perspective

George Ostapowicz, William M. Lee

Research output: Contribution to journalArticle

100 Citations (Scopus)

Abstract

Acute hepatic failure (AHF) is an uncommon, devastating syndrome, which results in death or the need for liver transplantation in more than 50% of cases. While AHF has numerous causes, most cases are due to viral hepatitis and drug toxicity or idiosyncratic reactions. A significant group with indeterminate causation remains, despite careful investigation. In many of these cases a viral aetiology is suspected, although yet not proven. Major differences exist in the aetiology of AHF between the West and Eastern countries. A wider range of aetiologies exists in the West. Common causes include acetaminophen toxicity and idiosyncratic drug reactions, while viral hepatitis is less frequent. Hepatitis E infection is rarely seen in Western countries in contrast to its high prevalence in the East. The mainstay of AHF management is supportive care in an intensive care unit. Liver transplantation is now the standard of care in many Western liver units for individuals who have a less than 20% probability of survival. Lack of availability of donor livers at short notice remains a significant problem. Methods of liver support used while waiting for a donor liver or for the native liver to regenerate include bioartificial livers, extracorporeal liver-assist devices, extracorporeal whole organ perfusion (human and transgenic pig) and hepatocyte transplantation. The effectiveness of these methods remains unproven and awaits controlled clinical trials. Both transplantation and liver-support methods require specialized units and expensive and complicated equipment. Further research is necessary to identify modalities of therapy that would be effective as well as widely accessible. (C) 2000 Blackwell Science Asia Pty Ltd.

Original languageEnglish (US)
Pages (from-to)480-488
Number of pages9
JournalJournal of Gastroenterology and Hepatology (Australia)
Volume15
Issue number5
DOIs
StatePublished - 2000

Fingerprint

Acute Liver Failure
Liver
Liver Transplantation
Drug-Related Side Effects and Adverse Reactions
Hepatitis
Artificial Liver
Hepatitis E
Equipment and Supplies
Controlled Clinical Trials
Standard of Care
Acetaminophen
Causality
Intensive Care Units
Hepatocytes
Swine
Perfusion
Transplantation
Survival
Infection
Research

Keywords

  • Acetaminophen
  • Acute hepatic failure
  • Fulminant hepatitis
  • Liver transplantation
  • Viral hepatitis

ASJC Scopus subject areas

  • Gastroenterology
  • Hepatology

Cite this

Acute hepatic failure : A Western perspective. / Ostapowicz, George; Lee, William M.

In: Journal of Gastroenterology and Hepatology (Australia), Vol. 15, No. 5, 2000, p. 480-488.

Research output: Contribution to journalArticle

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