Innovations to Improve Survival in Acute Liver Failure.

Acute liver failure (ALF) is a medical emergency with high mortality rates. Liver transplantation is the optimal treatment for eligible patients. However, it necessitates access to transplantation services, significant financial resources, and frequently poses challenges in ensuring safe transportation. Advances in intensive care have improved survival rates from 20% to over 60%. Key factors include early prognostication, dynamic modeling, neurocritical monitoring, and liver support systems. There is a significant need for better public health services for preventing and managing ALF in India, highlighting the importance of innovative healthcare delivery and algorithm-based care. Recent advancements in liver support systems, novel pharmacological approaches, and enhanced critical care protocols can improve transplant-free survival in ALF. Innovative strategies like early and accessible plasma exchange (PLEX) for rodenticide poisoning-related ALF in Tamil Nadu have offered hope for improving public health services to provide innovative therapeutics in resource-constrained settings. This comprehensive review aims to explore the latest advancements in the management of ALF covering pathobiology, prognostic scores and biomarkers, noninvasive monitoring of intracranial hypertension (optic nerve sheath diameter and transcranial Doppler) and the use of modalities such as PLEX, and continuous renal replacement therapy. We highlight advancements and explore future innovations to enhance outcomes for individuals with ALF. Additionally, we address epidemiological changes in ALF in India and the associated challenges for healthcare policy.