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Distribution, Drug Resistance, and Risk Factors of Infection in Liver Transplant Recipients With Liver Failure.

BACKGROUND: The aim of this study was to explore strategies for postoperative infection prevention and treatment, and how they might help to improve the prognosis in liver transplant recipients with liver failure. METHODS: We retrospectively investigated 98 recipients with liver failure in the Surgical Intensive Care Unit of The First Affiliated Hospital of Xi'an Jiaotong University from January 2019 to December 2023, and the pathogens distribution, drug resistance, and risk factors of infection after liver transplantation were analyzed. RESULTS: The incidence of infection was 48.0%, with co…

Autopsy of a 45-year-old Man with Liver Failure Due to Polycystic Liver Disease.

A 37-year-old man with autosomal dominant polycystic kidney disease (ADPKD) was admitted to our hospital with a liver volume of 8,000 cm3. Hepatic arterial embolization was performed using a microcoil but was ineffective. Eight years later, the hepatomegaly progressed to liver failure and death. At autopsy, the liver weighed 21.5 kg, and the entire liver had been replaced by cysts; in the few remaining areas of liver parenchyma, microscopic, small cysts of various sizes and fibrosis were evident, with only a few normal hepatocytes observed. Hepatic arterial branches developed; however, the por…

Model of Acute Liver Failure in an Isolated Perfused Porcine Liver-Challenges and Lessons Learned.

Acute liver failure (ALF) is a rare but devastating disease associated with substantial morbidity and a mortality rate of almost 45%. Medical treatments, apart from supportive care, are limited and liver transplantation may be the only rescue option. Large animal models, which most closely represent human disease, can be logistically and technically cumbersome, expensive and pose ethical challenges. The development of isolated organ perfusion technologies, originally intended for preservation before transplantation, offers a new platform for experimental models of liver disease, such as ALF. I…

Clinical and prognostic associations of liver volume determined by computed tomography in acute liver failure.

BACKGROUND: Liver volume (LV) can be non-invasively determined from the analysis of computed tomography (CT) images, and in patients with acute liver injury (ALI) or failure (ALF), it can reflect the balance of structural collapse with hepatic regeneration. We examined its relation to cause of liver injury, measures of liver function and histopathological findings, and utility in prediction of complications and mortality. METHODS: Two hundred and seventy-three patients with ALF/ALI admitted to a specialist intensive care unit were studied. One hundred and ninety-nine patients (73%) had non-ac

Analysis of infectious complications and timing for emergency liver transplantation in autoimmune acute liver failure.

BACKGROUND: Autoimmune hepatitis (AIH) is one of major etiologies of acute liver failure (ALF), and the survival rate without liver transplantation (LT) of patients with fulminant AIH is especially poor worldwide. We investigated the clinicopathological features of infectious complications in autoimmune ALF retrospectively and tried to determine when to continue corticosteroid (CS) treatment or abandon it for LT. METHODS: Twenty patients with autoimmune ALF, comprising five severe hepatitis, 13 fulminant hepatitis and two late onset hepatic failure, were analyzed. RESULTS: Corticosteroids we…

The changes in treatment strategies in ABOi living donor liver transplantation for acute liver failure.

INTRODUCTION: Living donor liver transplantation (LDLT) using ABO-incompatible (ABOi) graft for acute liver failure (ALF) is a developing treatment modality. METHODS: We reviewed the changes in our treatment strategies in applying ABOi LDLT for FH over our fourteen years of experience. RESULTS: Five patients with ALF received LDLT in adults using ABOi grafts, with different but gradually renewed protocols. The etiologies for acute liver failure included autoimmune hepatitis (n=3) and unknown (n=2). The desensitization protocol for ABOi barrier included Case #1; local infusion (portal vein)+p…

Acute liver failure secondary to metastatic liver infiltration: case report and review of the literature.

We present the case of a patient who died from multiple organ failure due to acute liver failure as a result of malignant hepatic infiltration by an adenocarcinoma. A review of the literature revealed that the clinical picture, laboratory examination, and imaging studies do not contribute to the diagnosis of this rare cause of liver failure. Therefore, liver biopsy should be considered early in the process, as this diagnosis is a contraindication for orthotopic liver transplantation.

Combined liver-kidney and liver transplantation in patients with renal failure outcomes in the MELD era.

With the implementation of the Model for End-Stage Liver Disease (MELD) scoring system, the number of combined liver-kidney transplants (CLKT) has increased dramatically. The United Network for Organ Sharing (UNOS) dataset was analysed for adult recipients with renal failure for the period between February 2002 and April 2006. This group was subdivided into patients on hemodialysis (HD) and to those not on HD prior to transplantation. All recipients in renal failure (serum creatinine > or =2.5 mg/dl) at the time of transplantation were included. A total of 1397 subjects were in renal failure b

Etiology and outcome of acute liver failure: experience from a liver transplantation centre in Montreal.

BACKGROUND: Acute liver failure is a rare condition in which massive liver injury is associated with the rapid development of hepatic encephalopathy. Although viral hepatitis and drug-induced liver injury are the most common causes, no specific etiology is found in a substantial proportion of cases reported from Europe and the United States. AIM: To determine the etiology and outcome of patients with acute liver failure in the authors' institution. PATIENTS AND METHODS: The charts of 81 consecutive patients admitted to Saint-Luc between 1991 and 1999 were reviewed. RESULTS: The etiology was…

Liver transplantation in a patient with acute liver failure due to sickle cell intrahepatic cholestasis.

BACKGROUND: Sickle cell intrahepatic cholestasis is a potentially catastrophic complication of sickle cell anemia Once acute liver failure develops, transplantation is the only option. We describe a patient with sickle cell intrahepatic cholestasis who underwent liver transplantation. METHODS: Data were obtained from the chart. Serial hemoglobin S levels were monitored, and measures were taken to maintain hemoglobin S <20% to prevent sickle cell crisis. RESULTS: Although the allograft functioned well initially, the patient developed veno-occlusive disease and required repeat transplantation …

Dynamic liver radionuclide scanning in the evaluation of liver failure and portal hypertension in cirrhotic patients.

Dynamic liver radionuclide scanning was performed in cirrhotic patients to correlate three parameters derived by this technique to the severity of liver function impairment and clinical-endoscopic signs of portal hypertension. We found a close association between the severity of liver failure (Child-Pugh criteria) and both the relative blood flow (p < 0.05) and the shape (shifting to the left) of the early flow curve (p < 0.01). A significant association between the presence of portal hypertension and shifting to the left of the flow curve was demonstrated in all cases in which tense ascites w…

Diagnosis and Management of Intracranial Hypertension in Acute Liver Failure.

Acute liver failure is a rare disease characterized by acute presentation of liver injury in the absence of cirrhosis that poses significant morbidity and mortality. Neurological manifestations, including hepatic encephalopathy, cerebral edema and intracranial hypertension, are frequent. The incidence of intracranial hypertension in acute liver failure has declined, which is a likely reflection of the impact of early and adequate intervention, but it holds a poor prognosis. This review summarizes the key concepts relating to pathophysiology, diagnosis and management of intracranial hypertensio…

The Liver in Heart Failure and Adults with Congenital Heart Disease.

Liver disease is common in patients with heart failure, often resulting from hepatic congestion and decreased perfusion due to reduced cardiac output. Patients with congenital heart disease (CHD) are particularly susceptible to hepatic injury due to their complex physiology, both before and following surgical interventions. Individuals with single-ventricle CHD who have undergone the Fontan procedure are especially prone to developing Fontan-associated liver disease (FALD). Screening and managing FALD remains challenging, necessitating a multidisciplinary approach to guide patient-care and to

Pharmacological Management for Prevention and Treatment of Posthepatectomy Liver Failure.

BACKGROUND: Posthepatectomy liver failure (PHLF) remains a leading cause of morbidity and mortality following major liver resection. Despite advances in surgical techniques and perioperative care, treatment options for PHLF are limited. Pharmacological interventions targeting ischemia-reperfusion injury and portal flow modulation have gained interest as potential therapeutic strategies. SUMMARY: This review provides a clinically applicable overview of the current evidence on pharmacological management of PHLF. Perioperative glucocorticoids may reduce inflammatory complications and lower PHLF …

Hepatitis E as a trigger for acute-on-chronic liver failure.

Acute hepatitis E virus (HEV) infection is typically self-limiting and has a favourable prognosis. However, certain populations such as patients with pre-existing chronic liver disease may experience severe manifestations, including progression to acute-on-chronic liver failure (ACLF). Among viral hepatitis types, hepatitis A, E, and B are major causes of ACLF. Active screening and early diagnosis of HEV infection in patients with cirrhosis, especially those who develop ACLF, can improve management and enable timely antiviral therapy. Preventive measures, including HEV vaccination for high-ris…

Fomepizole Therapy for Acetaminophen-Induced Liver Failure in an Infant.

Acetaminophen overdose is common in the pediatric population. N-acetylcysteine (NAC) is effective at preventing liver injury in most patients when started shortly after the overdose. Delays to therapy increase risk of hepatotoxicity and liver failure that may necessitate organ transplant. Animal studies have demonstrated fomepizole may provide added benefit in acetaminophen overdose because of its ability to block the metabolic pathway that produces the toxic acetaminophen metabolite and downstream inhibition of oxidative stress pathways that lead to cell death. Several adult case reports desc…

A Comprehensive Review of the Diagnosis and Management of Acute Liver Failure.

Acute liver failure (ALF) is a rare and specific form of severe hepatic dysfunction characterized by coagulopathy and hepatic encephalopathy in a patient with no known liver disease. ALF carries a high morbidity and mortality. Careful attention should be given to hemodynamics and metabolic parameters along with the active surveillance of infections. Timely transfer and supportive management are important in an intensive care unit in a liver transplant center. Identifying patients who will and will not improve with medical management and may need emergent liver transplantation is critical. In t…

Фиброгенный процесс и высвобождение острой печени на хроническую недостаточность.

Острая поверхностная недостаточность печени (АФОО) представляет собой опасное для жизни состояние, характеризующееся быстрым ухудшением ранее хорошо компенсированных хронических заболеваний печени. Одним из основных препятствий в деятельности АФОА является отсутствие знаний о патогенезе и конкретных видах лечения широкого спектра. Для объяснения патогенеза АФОО было предложено чрезмерное системное воспалительное реагирование; эта гипотеза касается ошеломляющих клеток, которые связаны со многими гомеостатическими функциями печени, включая хранение витамина А, регулирование синусоидального поток

Совпадение в аннотации оригинала
Acute-on-chronic liver failure (ACLF) is a life-threatening condition characterized by a rapid deterioration of previously well-compensated chronic liver diseases. One of the main obstacles in ACLF is the lack of knowledge of the pathogenesis and specific broad-spectrum treatments. An excessive systemic inflammatory response has been proposed to explain the …