Acute liver failure--practical management.

The three most important components of the management of Acute Liver Failure are:- 1) Identification of causes requiring specific treatment including hepatic lymphoma, the Budd-Chiari syndrome, ischaemic hepatic necrosis, fulminating septicaemia, Wilson's disease and reactivation of HBV in chronic carriers. 2) Institution of early monitoring and optimal intensive care for multi-organ involvement to improve chances of spontaneous recovery or of transplantation. Deteriorating encephalopathy with cerebral oedema is related to a systemic inflammatory response and infections need to be treated aggressively. 3) Assessment of the need for transplantation based on strong positive predictive values provided by the King's or Clichy criteria. A significant percentage of those not fulfilling criteria also progress. The MARS liver support device has corrective effects on the disturbed pathophysiology of ALF and may be used to enhance spontaneous recovery or as a bridge to transplant, although the latter is not yet proven by controlled clinical trial.