Acute liver failure and transplantation: A symposium

✍ Scribed by Lee, William M. ;Maddrey, Willis C.

• Publisher: Wiley (John Wiley & Sons)
• Year: 1995
• Tongue: English
• Weight: 190 KB
• Volume: 1
• Category: Article
• ISSN: 1074-3022
• DOI: 10.1002/lt.500010307

✦ Synopsis

he clinical manifestations of acute liver failure T are usually dominated by evidence of progressively worsening hepatic encephalopathy, profound disturbances in coagulation, and the onset of cerebral edema. The rapid onset and clinical deterioration of these patients are alarming to the clinician and require rapid but thoughtful action. There are many unresolved issues regarding evaluation and management of patients who have rapidly advancing hepatocellular failure. The purpose of this symposium is to address some of these issues, with a particular focus on the role of transplantation as primary treatment for acute liver failure.

Patients with acute liver failure are uniquely disarmed of their protective mechanisms: against infection, bleeding, encephalopathy, and edema. Medical therapy has thus far proved to be generally disappointing and frequently unsuccessful. In these situations, the physician often watches, waits, tinkers, and hopes. Management gains over the years have been the result of increasing recognition of the complications specific to liver failure that may prove fatal, as well as control of the more mundane but no less important aspects of intensive care such as maintenance of airway, management of fluid balance, prevention of aspiration, and avoidance of inappropriate medications. Improvements in survival over the past 30 years have occurred, not because of transplantation alone, but also because of improvements in intensive care management of acute liver failure patients.

The advent of liver transplantation changed the expectations of therapy and has become standard of care for treatment of patients with advanced acute liver failure. Because of the initial costs of transplanta-From the Liver Unit, Department of Internal Medicine, Unwersify