Current Gastroenterology Reports

, Volume 9, Issue 1, pp 66–73 | Cite as

Epidemiology of acute liver failure

  • Mouen Khashab
  • A. Joseph Tector
  • Paul Y. Kwo


Acute liver failure (ALF) is an uncommon disorder that leads to jaundice, coagulopathy, and multisystem organ failure. Its definition is based on the timing from onset of jaundice to encephalopathy. In 2005, ALF accounted for 6% of liver-related deaths and 7% of orthotopic liver transplants (OLT) in the United States. Several classification systems have been developed for ALF, with the King’s College criteria most widely used for prediction of OLT. Specific diagnostic tests should be implemented to identify the cause of ALF, which will help to determine its treatment and prognosis. Viral hepatitis was previously reported to be the most common cause of ALF in the United States, but acetaminophen overdose and idiosyncratic drug reactions have emerged as the most frequent causes in recent studies. Malignancy is an uncommon cause of ALF, and thus imaging studies may not be useful in this setting, but liver biopsy may be beneficial in selected cases. An overall strategy for ALF should start with identifying the cause, assessing the prognosis, and early transfer to a transplantation center for suitable candidates. OLT has emerged as a life-saving procedure leading to marked improvement in survival rates. Improved surgical techniques, immunosuppression, and comprehensive care have led to an overall survival rate of approximately 65% with OLT. N-acetylcysteine is effective in ALF caused by acetaminophen overdose, with results strongly related to how soon it is given rather than the route of administration. Liver support systems show potential for the treatment of ALF, but their role needs validation in large multicenter randomized trials.


Imatinib International Normalize Ratio Transjugular Intrahepatic Portosystemic Shunt Orlistat Acute Liver Failure 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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References and Recommended Reading

  1. 1.
    Rakela J, Lange SM, Ludwig J, Baldus WP: Fulminant hepatitis: Mayo Clinic experience with 34 cases. Mayo Clin Proc 1985, 60:289–292.PubMedGoogle Scholar
  2. 2.
    Ostapowicz G, Fontana RJ, Schiodt FV, et al.: Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002, 137:947–954.PubMedGoogle Scholar
  3. 3.
    Hoofnagle JH, Carithers RLJ, Shapiro C, Ascher N: Fulminant hepatic failure: summary of a workshop. Hepatology 1995, 21:240–252.PubMedGoogle Scholar
  4. 4.
    Sakaida I, Kimura T, Yamasaki T, et al.: Cytochrome c is a possible new marker for fulminant hepatitis in humans. J Gastroenterol 2005, 40:179–185.PubMedCrossRefGoogle Scholar
  5. 5.
    Hiraoka A, Horiike N, Akbar SM, et al.: Soluble CD163 in patients with liver diseases: very high levels of soluble CD163 in patients with fulminant hepatic failure. J Gastroenterol 2005, 40:52–56.PubMedCrossRefGoogle Scholar
  6. 6.
    Miyake Y, Sakaguchi K, Iwasaki Y, et al.: New prognostic scoring model for liver transplantation in patients with non-acetaminophen-related fulminant hepatic failure. Transplantation 2005, 80:930–936.PubMedCrossRefGoogle Scholar
  7. 7.
    Arai M, Yokosuka O, Kanda T, et al.: Serum osteopontin levels in patients with acute liver dysfunction. Scand J Gastroenterol 2006, 41:102–110.PubMedCrossRefGoogle Scholar
  8. 8.
    Bernal B: Changing patterns of causation and the use of transplantation in the United Kingdom. Semin Liver Dis 2003, 23:227–237.PubMedCrossRefGoogle Scholar
  9. 9.
    Polard E, Camus C, Abault AY, et al.: Retransplantation for acute liver failure due to combined antiviral agents in an HIV-HCV coinfected liver transplant recipient. Transplantaton 2005, 80:1136–1138.CrossRefGoogle Scholar
  10. 10.
    Lewis W, Day BJ, Copeland WC: Mitochondrial toxicity of NRTI antiviral drugs: an integrated cellular perspective. Nat Rev Drug Discov 2003, 2:812–822.PubMedCrossRefGoogle Scholar
  11. 11.
    Lafeuillade A, Hittinger G, Chapadaud S: Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection. Lancet 2001, 357:280.PubMedCrossRefGoogle Scholar
  12. 12.
    Qazilbash MH, Qu Z, Hosing C, et al.: Rituximab-induced acute liver failure after an allogeneic transplantation for chronic myeloid leukemia. Am J Hematol 2005, 80:43–45.PubMedCrossRefGoogle Scholar
  13. 13.
    Cross TJ, Bagot C, Portmann B, et al.: Imatinib mesylate as a cause of acute liver failure. Am J Hematol 2006, 81:189–192.PubMedCrossRefGoogle Scholar
  14. 14.
    Clay KD, Hanson JS, Pope SD, et al.: Brief communication: severe hepatotoxicity of telithromycin: three case reports and literature review. Ann Intern Med 2006, 144:142Google Scholar
  15. 15.
    Hanje AJ, Pell LJ, Votolato NA, et al.: Case report: Fulminant hepatic failure involving duloxetine hydrochloride. Clinical Gastroenterol Hepatol 2006, 4:912–917.CrossRefGoogle Scholar
  16. 16.
    Thurairajah PH, Syn WK, Neil DA, et al.: Orlistat (Xenical)-induced subacute liver failure. Eur J Gastroenterol Hepatol 2005, 17:1437–1438.PubMedCrossRefGoogle Scholar
  17. 17.
    Yeo W, Johnson PJ: Diagnosis, prevention and management of hepatitis B virus reactivation during anticancer therapy. Hepatology 2006, 43:209–220.PubMedCrossRefGoogle Scholar
  18. 18.
    Montalbano M, Slapak-Green GI, Neff GW: Fulminant hepatic failure from herpes simplex virus: post liver transplantation acyclovir therapy and literature review. Transplant Proc 2005, 37:4393–4396.PubMedCrossRefGoogle Scholar
  19. 19.
    Ichai P, Afonso IS, Sebagh M, et al.: Herpes simplex virus-associated acute liver failure: a difficult diagnosis with a poor prognosis. Liver Transpl 2005, 11:1550–1555.PubMedCrossRefGoogle Scholar
  20. 20.
    Mantadakis E, Anagnostatou N, Danilatou V, et al.: Fulminant hepatitis due to varicella zoster virus in a girl with acute lymphoblastic leukemia in remission: report of a case and review. J Pediatr Hematol Oncol 2005, 27:551–553.PubMedCrossRefGoogle Scholar
  21. 21.
    Cacheux W, Carbonell N, Rosmorduc O, et al.: HHV-6-related acute liver failure in two immunocompetent adults: favourable outcome after liver transplantation and/or ganciclovir therapy. J Intern Med 2005, 258:573–578.PubMedGoogle Scholar
  22. 22.
    Dutta U, Mittal S, Ratho RK, Das A: Acute liver failure and severe hemophagocytosis secondary to parvovirus B19 infection. Indian J Gastroenterol 2005, 24:118–119.PubMedGoogle Scholar
  23. 23.
    Devarbhavi H, Alvares JF, Kumar KS: Severe falciparum malaria simulating fulminant hepatic failure. Mayo Clin Proc 2005, 80:355–358.PubMedCrossRefGoogle Scholar
  24. 24.
    Tillmann HL, Hadem J, Leifeld L, et al.: Safety and efficacy of lamivudine in patients with severe acute or fulminant hepatitis B, a multicenter experience. J Viral Hepat 2006, 13:256–263.PubMedCrossRefGoogle Scholar
  25. 25.
    Harrison HM, Crosby J Jr: Fulminant hepatic failure: an unusual presentation of metastatic liver disease. Gastroenterology 1981, 80:820–825.PubMedGoogle Scholar
  26. 26.
    Nakagawa K, Miller FN, Sims DE, et al.: Mechanisms of interleukin-2-induced hepatic toxicity. Cancer Res 1996, 56:507–510.PubMedGoogle Scholar
  27. 27.
    McElreath DP, Angtuaco TL, Staggs B, Malik AH: T cell prolymphocytic leukemia: a rare cause of acute liver failure. Dig Dis Sci 2006, 51:819–821.PubMedCrossRefGoogle Scholar
  28. 28.
    Boyiadzis M, Nam M, Dahut W: Fulminant hepatic failure secondary to metastatic prostate cancer. Urol Int 2005, 74:185–187.PubMedCrossRefGoogle Scholar
  29. 29.
    Kaplan GG, Medllicott S, Culleton B, Laupland KB: Acute hepatic failure and multi-system organ failure secondary to replacement of the liver with metastatic melanoma. BMC Cancer 2005, 5:67.PubMedCrossRefGoogle Scholar
  30. 30.
    Rajvanshi P, Kowdley KV, Hirota WK, et al.: Fulminant hepatic failure secondary to neoplastic infiltration of the liver. J Clin Gastroenterol 2005, 39:339–343.PubMedCrossRefGoogle Scholar
  31. 31.
    Cameron AM, Truty J, Truell J, et al.: Fulminant hepatic failure from primary hepatic lymphoma: successful treatment with orthotopic liver transplantation and chemotherapy. Transplantation 2005, 80:993–996.PubMedCrossRefGoogle Scholar
  32. 32.
    Fussell KM, Awad JA, Ware LB: Case of fulminant hepatic failure due to unrecognized peripartum cardiomyopathy. Crit Care Med 2005, 33:891–893.PubMedCrossRefGoogle Scholar
  33. 33.
    Abujudeh H, Contractor D, Delatorre A, Koneru B: Rescue TIPS in acute Budd-Chiari syndrome. Am J Roentgenol AJR 2005, 185:89–91.Google Scholar
  34. 34.
    Ganger DR, Klapman JB, McDonald V, et al.: Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis: review of indications and problems. Am J Gastroenterol 1999, 94:603–608.PubMedGoogle Scholar
  35. 35.
    Verhoeven NM, Wallot M, Huck JH, et al.: A newborn with severe liver failure, cardiomyopathy and transaldolase deficiency. J Inher Metabol Dis 2005, 28:169–179.CrossRefGoogle Scholar
  36. 36.
    Fiedler A, Wichers-Rother M, Hoeft A, et al.: Schmidt syndrome presenting as acute liver failure. Exp Clin Endocrinol Diabetes 2005, 113:60–63.PubMedCrossRefGoogle Scholar
  37. 37.
    Kessler WR, Cummings OW, Eckert G, et al.: Fulminant hepatic failure as the initial presentation of acute autoimmune hepatitis. Clin Gastroenterol Hepatol 2004, 2:625–631.PubMedCrossRefGoogle Scholar
  38. 38.
    Buckley NA, Whyte IM, O’Connell DL, Dawson AH: Oral or intravenous N-acetylcysteine: which is the treatment of choice for acetaminophen (paracetamol) poisoning? Clin Toxicol 1999, 37:759–767.CrossRefGoogle Scholar
  39. 39.
    Kearney TE: Acetylcysteine. In Poisoning and Drug Overdose. Edited by Olson KR. New York: Lange Medical Books/McGraw-Hill; 2004:405–407.Google Scholar
  40. 40.
    Ascher NL, Lake JR, Emond JC, Roberts JP: Liver transplantation for fulminant hepatic failure. Arch Surg 1993, 128:677–682.PubMedGoogle Scholar
  41. 41.
    Montalti R, Nardo B, Beltempo P, et al.: Liver transplantation in fulminant hepatic failure: experience with 40 adult patients over a 17-year period. Transplant Proc 2005, 37:1085–1087.PubMedCrossRefGoogle Scholar
  42. 42.
    Pinelli D, Spada M, Lucianetti A, et al.: Transplantation for acute liver failure in children. Transplant Proc 2005, 37:1146–1148.PubMedCrossRefGoogle Scholar
  43. 43.
    Nyckowski P, Skwarek A, Zieniewicz K, et al.: Orthotopic liver transplantation for fulminant hepatic failure. Transplant Proc 2006, 38:219–220.PubMedCrossRefGoogle Scholar
  44. 44.
    Tissieres P, Sasbon JS, Devictor D: Liver support for fulminant hepatic failure: is it time to use the molecular adsorbents recycling system in children? Pediatr Crit Care Med 2005, 6:585–591.PubMedCrossRefGoogle Scholar
  45. 45.
    Lee KH, Lee MK, Sutedja DS, Lim SG: Outcome from molecular adsorbent recycling system (MARS) liver dialysis following drug-induced liver failure. Liver Int 2005, 25:973–977.PubMedCrossRefGoogle Scholar
  46. 46.
    Sein Anand J, Chodorowsk Z, Hydzik P: Molecular adsorbent recirculating system: MARS as a bridge to liver transplantation in amanita phalloides intoxication. Przeglad Lekarski 2005, 62:480–481.PubMedGoogle Scholar
  47. 47.
    Doria C, Mandala L, Scott VL, et al.: Fulminant hepatic failure bridged to liver transplantation with a molecular adsorbent recirculating system: a single-center experience. Dig Dis Sci 2006, 51:47–53.PubMedCrossRefGoogle Scholar
  48. 48.
    Tsai MH, Chen YC, Wu CS, et al.: Extracorporal liver support with molecular adsorbents recirculating system in patients with hepatitis B-associated fulminant hepatic failure. Int J Clin Pract 2005, 59:1289–1294.PubMedCrossRefGoogle Scholar
  49. 49.
    Du WB, Li LJ, Huang JR, et al.: Effects of artificial liver support system on patients with acute or chronic liver failure. Transplant Proc 2005, 37:4359–4364.PubMedCrossRefGoogle Scholar
  50. 50.
    Inderbitzin D, Muggli B, Ringger A, et al.: Molecular absorbent recirculating system for the treatment of acute liver failure in surgical patients. J Gastrointest Surg 2005, 9:1155–1161.PubMedCrossRefGoogle Scholar
  51. 51.
    O’Grady JG, Alexander GJ, Hayllar KM, Williams R: Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989, 97:439–445.PubMedGoogle Scholar
  52. 52.
    O’Grady JG: Acute liver failure. Postgrad Med J 2005, 81:148–154.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Division of Gastroenterology and Hepatology, Department of MedicineIndiana University School of MedicineIndianapolisUSA

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