Acute Liver Failure

Acute liver failure (ALF) is a progressive life-threatening condition characterized by hepatic dysfunction with coagulopathy and hepatic encephalopathy (HE) that evolves over a few days or weeks. Besides development of HE, ALF results in development of multi-organ failure (MOF), and is still associated with a ~40% mortality risk depending on the etiology and severity of liver injury. The prognosis for ALF patients has improved significantly over the last 3 decades due to advances in medical critical care management, including early treatment of hyperammonemia, renal insufficiency and the use of high-volume plasma exchange (HVP). Liver transplantation is the ultimate treatment option. In this short review we mainly focus on the basic medical management of patients with ALF and on the value of liver support by HVP in the waiting time for spontaneous recovery of the liver or to ensure vital organ stability before liver transplantation.