Massive hepatic necrosis-associated acute liver failure.

Massive hepatic necrosis (MHN), characterised by extensive loss of hepatocytes, represents the most severe pathological lesion in acute liver failure (ALF). MHN-associated ALF primarily occurs in patients with acute viral hepatitis A, B or E infections. Additionally, MHN-associated ALF can develop in patients with autoimmune hepatitis or in those taking idiosyncratic drugs. MHN-associated ALF is associated with significantly higher mortality than that caused by other aetiologies. In contrast to other forms of ALF, liver regeneration following MHN depends on liver progenitor cells (LPCs)-the smallest cholangiocytes localising in the canal of Hering and terminal biliary branches. These cells play key roles in determining the clinical outcome of patients with MHN-associated ALF. This paper reviews the pathophysiology of MHN-associated ALF and recent advances in LPC biology.