Skip to main content

Akutes Leberversagen

Aktuelle Aspekte zur Diagnostik und Therapie

Acute liver failure

Current aspects of diagnosis and therapy

Der Anaesthesist volume 53, pages 511–530 (2004)Cite this article

Zusammenfassung

Störungen der Partialfunktionen der Leber, wie Synthese, Exkretion oder Biotransformation, sind für Verlauf und Prognose des Patienten mit Multiorgandysfunktion von maßgeblicher Bedeutung und werden bei Betrachtung klassischer Parameter, wie Serumtransaminasen oder -bilirubin in ihrer Inzidenz unterschätzt. Umgekehrt bestimmen extrahepatische Komplikationen, wie hyperdynames Kreislaufversagen, hepatorenales Syndrom (HRS) oder hepatische Enzephalopathie (HE), die Prognose des akuten Leberversagens im engeren Sinne. Für die Diagnose „akutes Leberversagen“ wird neben Koagulopathie und Ikterus daher auch die HE herangezogen. Zur Verlaufsbeurteilung des Patienten mit akutem Leberversagen oder schwerer Leberdysfunktion im Rahmen des Multiorganversagens werden heute neben klassischen „statischen“ Parametern, wie Serumbilirubin „dynamische“ Tests, die den aktuellen Funktions- und Perfusionszustand der Leber anhand komplexer Leistungen, z. B. der Elimination des Farbstoffs Indozyaningrün, ermitteln, empfohlen. Neben spezifischen oder kausalen Behandlungsmöglichkeiten, wie der Gabe von N-Acetylcystein (NAC) bei der Paracetamolintoxikation oder der Beendigung der Schwangerschaft beim HELLP-Syndrom (hemolysis, elevated liver enzymes, low platelet counts), stehen mit der Gabe von Albumin und Terlipressin und der extrakorporalen Unterstützung der Entgiftungsfunktion, z. B. mit der Albumindialyse, aktuell neue Behandlungskonzepte zur Verfügung, die in aktuellen Studien eine günstige Beeinflussung der schlechten Prognose des Leberversagens nahe legen. Beim akuten Leberversagen mit erwarteter Letalität >80% bleibt dagegen die Lebertransplantation das Therapieverfahren der Wahl.

Abstract

Disturbances of some partial liver functions, such as synthesis, excretion, or biotransformation of xenobiotics, are important for prognosis and ultimate survival in patients presenting with multiple organ dysfunction on the intesive care unit (ICU). The incidence of liver dysfunction is underestimated when traditional “static” measures such as serum-transaminases or bilirubin as opposed to “dynamic” tests, such as clearance tests, are used to diagnose liver dysfunction. Similar to the central role of the failing liver in MODS, extrahepatic complications, such as hepatorenal syndrome and brain edema develop in acute or fulminant hepatic failure and determine the prognosis of the patient. This is reflected in the required presence of hepatic encephalopathy in addition to hyperbilirubinemia and coagulopathy for the diagnosis of acute liver failure. In addition to these clinical signs, dynamic tests, such as indocyanine green clearance, which is available at the bed-side, are useful for the monitoring of perfusion and global liver function. In addition to specific and causal therapeutic interventions, e.g. N-acetylcysteine for paracetamol poisoning or termination of pregnancy for the HELLP-syndrome, new therapeutic measures, e.g. terlipressin/albumin or albumin dialysis are likely to improve the poor prognosis of acute-on-chronic liver failure. Nevertheless, liver transplantation remains the treatment of choice for fulminant hepatic failure when the expected survival is <20%.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6
Abb. 7
Abb. 8

Literatur

  1. Abraham SC, Furth EE (1995) Receiver operating characteristic analysis of serum chemical parameters as tests of liver transplant rejection and correlation with histology. Transplantation 59:740–746

    CAS  PubMed  Google Scholar 

  2. Als-Nielsen B, Kjaergard LL, Gluud C (2004) Benzodiazepine receptor antagonist for acute and chronic hepatic encephalopathy (Cochrane review). In: The Cochrane Library, Issue I, 2004. Wiley & Sons, Chichester

  3. Als-Nielsen B, Koretz RL, Kjaergard LL, Gluud C (2004) Branched-chain amino acids for hepatic encephalopathy (Cochrane review). In: The Cochrane Library, Issue I, 2004. Wiley & Sons, Chichester

  4. Angeli P, Volpin R, Gerunda G et al. (1999) Reversal of type I hepatorenale syndrome with the administration of midodrine and octreotide. Hepatology 29:1690–1697

    CAS  PubMed  Google Scholar 

  5. Angus DC, Linde-Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR (2001) Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med 29:1303–1310

    CAS  PubMed  Google Scholar 

  6. Arrigoni A, Gindro T, Aimo G et al. (1994) Monoethylglycinexylidide test: a prognostic indicator of survival in cirrhosis. Hepatology 20:383–387

    CAS  PubMed  Google Scholar 

  7. Aruoma OI, Halliwell B, Hoey BM, Butler J (1989) The antioxidant action of N-acetylcysteine: its reaction with hydrogen peroxide, hydroxyl radical, superoxide, and hypochlorous acid. Free Radic Biol Med 6:593–597

    CAS  PubMed  Google Scholar 

  8. Awad SS, Swaniker F, Bartlett RH (2001) Results of a phase I trial evaluating an extracorporeal hepatic support device utilizing albumin dialysis. Z Gastroenterol Suppl 39:22–23

    Google Scholar 

  9. Ayuse T, Brienza N, Revelly JP, O’Donnell CP, Boitnott JK, Robotham JL (1995) Alterations in liver hemodynamics in an intact porcine model of endotoxin shock. Am J Physiol 268:H1106–1114

    CAS  PubMed  Google Scholar 

  10. Azouly D, Samuel D, Ichai P et al. (2001) Auxiliary partial orthotopic versus standard orthotopic whole liver transplantation for acute liver failure. Ann Surg 234:723–731

    Article  PubMed  Google Scholar 

  11. Baker AL, Krager PS, Kotake AN, Schoeller DA (1987) The aminopyrine breath test does not correlate with histologic disease severity in patients with cholestasis. Hepatology 7:464–467

    CAS  PubMed  Google Scholar 

  12. Bargetzi MJ, Aoyama T, Gonzalez FJ, Meyer UA (1989) Lidocaine metabolism in human liver microsomes by cytochrome P450IIIA4. Clin Pharmacol Ther 46:521–527

    CAS  PubMed  Google Scholar 

  13. Bauer M (1996) Pathophysiologie der Sepsis. Aktuelle Konzepte. Anästhesist 45:312–322

  14. Bauer M, Pannen BHJ, Bauer I et al. (1996) Evidence for a functional link between stress response and vascular control in hepatic portal circulation. Am J Physiol 271:G929–935

    CAS  PubMed  Google Scholar 

  15. Beavers KL, Sandler RS, Shrestha R (2002) Donor morbidity associated with right lobectomy for living donor liver transplantation to adult recipients: a systematic review. Liver Transpl 8:110–117

    Article  PubMed  Google Scholar 

  16. Ben Abraham R, Szold O, Merhav H et al. (2001) Rapid resolution of brain edema and improved cerebral perfusion pressure following the molecular adsorbent recycling system in acute liver failure. Transplant Proc 33:2897–2899

    PubMed  Google Scholar 

  17. Berghe G van den, Wouters P, Weekers F et al. (2001) Intensive insulin therapy in critically ill patients. N Engl J Med 345:1359–1367

    PubMed  Google Scholar 

  18. Berlakovich GA, Hetz H, Faybik P, Baker A, Steininger R, Steltzer H, Muehlbacher F (2002) MARS for the treatment of primary dysfunction post liver transplantation (abstract). 4th Symposium on Albumin Dialysis in Liver Disease, Rostock-Warnemünde

  19. Bernal W, Donaldson N, Wyncoll D, Wendon J (2002) Blood lactate as an early predictor of outcome in paracetamol-induced acute liver failure: a cohort study. Lancet 359:558–563

    Article  CAS  PubMed  Google Scholar 

  20. Bernuau J, Samuel D, Durand F (1991) Criteria for emergency liver transplantation in patients with acute viral hepatitis and factor V below 50% of normal: a prospective study (abstract). Hepatology 14:49A

    Google Scholar 

  21. Bianchi G, Marchesini G, Vilstrup H, Fabbri A, Mitri MS de, Zoli M, Pisi E (1991) Hepatic amino-nitrogen clearance to urea-nitrogen in control subjects and in patients with cirrhosis: a simplified method. Hepatology 13:460–466

    CAS  PubMed  Google Scholar 

  22. Bilir BM, Guinette D, Karrer F et al. (2000) Hepatocyte transplantation in acute liver failure. Liver Transpl 6:32–40

    CAS  PubMed  Google Scholar 

  23. Böker KHW (2001) Akutes Leberversagen. Internist 42:545–563

    PubMed  Google Scholar 

  24. Borgstroem L, Kagedal B, Paulsen O (1986) Pharmacokinetics of N-acetylcysteine in man. Eur J Clin Pharmacol 31:217–222

    PubMed  Google Scholar 

  25. Brandsaeter B, Höckerstedt K, Friman S et al. (2002) Fulminant hepatic failure: outcome after listing for highly urgent liver transplantation—12 years experience in the nordic countries. Liver Transpl 8:1055–1062

    Article  PubMed  Google Scholar 

  26. Brensing KA, Textor J, Perz J et al. (2000) Long-term outcome after transjugular intrahepatic portosystemic stent-shunt in non-transplant cirrhotics with hepatorenale syndrome: a phase II study. Gut 47:288–295

    Article  CAS  PubMed  Google Scholar 

  27. Broelsch CE, Frilling A, Testa G, Malago M (2003) Living donor liver transplantation in adults. Eur J Gastroenterol Hepatol 15:3–6

    Article  PubMed  Google Scholar 

  28. Brown JB, Emerick KM, Brown DL, Whitington PF, Alonso EM (2003) Recombinant factor VIIa improves coagulopathy caused by liver failure. J Pediatr Gastroenterol Nutr 37:268–272

    CAS  PubMed  Google Scholar 

  29. Bugg NC, Jones JA (1998) Hypophosphataemia. Pathophysiology, effects and management on the intensive care unit. Anaesthesia 53:895–902

    Google Scholar 

  30. Cabré E, Rodríguez-Iglesias P, Caballería J et al. (2000) Short- and long-term outcome of severe alcohol-induced hepatitis treated with steroid or enteral nutrition: a multicenter randomised trial. Hepatology 32:36–42

    Article  CAS  PubMed  Google Scholar 

  31. Campra JL, Reynolds TB (1988) The hepatic circulation. In: Arias IM, Jakoby WB, Popper H, Schachter D, Shafritz DA (eds) The liver: biology and pathobiology, 2nd edn. Raven Press, New York, pp 911–930

  32. Clowes GH Jr, McDermott WV, Williams LF, Loda M, Menzoian JO, Pearl R (1984) Amino acid clearance and prognosis in surgical patients with cirrhosis. Surgery 96:675–685

    PubMed  Google Scholar 

  33. D’Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberati A (1998) Effectiveness of antibiotic prophylaxis in critically ill adult patients: a systematic review of randomised controlled trials. BMJ 316:1275–1285

    CAS  PubMed  Google Scholar 

  34. Dargan PI, Jones AL (2002) Acetaminophen poisoning: an update for the intensivist. Crit Care 6:108–110

    Article  PubMed  Google Scholar 

  35. Deutschman CS, Maio A de, Buchman TG, Clemens MG (1993) Sepsis-induced alterations in phosphoenolpyruvate carboxykinase expression: the role of insulin and glucagon. Circ Shock 40:295–302

    CAS  PubMed  Google Scholar 

  36. Devlin J, Ellis AE, McPeake J, Heaton N, Wendon J, Williams R (1997) N-acetylcysteine improves indocyanine green extraction and oxygen transport during hepatic dysfunction. Crit Care Med 25:236–242

    Article  CAS  PubMed  Google Scholar 

  37. Ding YT, Qiu YD, Chen Z, Xu QX, Zhang HY, Tang Q, Yu DC (2003) The development of a new bioartificial liver and its application in 12 acute liver failure patients. World J Gastroenterol 9:829–832

    CAS  PubMed  Google Scholar 

  38. Druml W, Fischer M, Pidlich J, Lenz K (1995) Fat elimination in chronic hepatic failure: long-chain vs medium-chain triglycerides. Am J Clin Nutr 61:812–817

    CAS  PubMed  Google Scholar 

  39. Druml W, Fischer M, Ratheiser K (1998) Use of intravenous lipids in critically ill patients with sepsis without and with hepatic failure. JPEN J Parenter Enteral Nutr 22:217–223

    CAS  PubMed  Google Scholar 

  40. Duvoux C, Zanditenas C, Chauvat A, Monin JL, Roudot-Thoraval F, Mallat A, Dhumeaux D (2002) Effects of noradrenalin and albumin in patients with type I hepatorenale syndrome: a pilot study. Hepatology 36:374–380

    Article  CAS  PubMed  Google Scholar 

  41. Ellis AJ, Hughes RD, Wendon JA et al. (1996) Pilot-controlled trial of the extracorporeal liver assist device in acute liver failure. Hepatology 24:1446–1451

    CAS  PubMed  Google Scholar 

  42. Ercolani G, Grazi GL, Calliva R, Pierangeli F, Cescon M, Cavallari A, Mazziotti A (2000) The lidocaine (MEGX) test as an index of hepatic function: its clinical usefulness in liver surgery. Surgery 127:464–471

    CAS  PubMed  Google Scholar 

  43. Falkenhagen D, Strobl W, Vogt G, Schrefl A, Linsberger I, Gerner FJ, Schoenhofen M (1999) Fractionated plasma separation and adsorption system: a novel system for blood purification to remove albumin bound substances. Artif Organs 23:81–86

    Article  CAS  PubMed  Google Scholar 

  44. Fan ST, Wang QS, Lo CM, Tam Yu KW, Lai EC, Wong J (1994) Evaluation of indocyanine green retention and aminopyrine breath tests in patients with malignant biliary obstruction. Aust N Z J Surg 64:759–762

    CAS  PubMed  Google Scholar 

  45. Farmer DG, Anselmo DM, Ghobrial M et al. (2003) Liver transplantation for fulminant hepatic failure—Experience with more than 200 patients over a 17-year period. Ann Surg 237:666–676

    Article  PubMed  Google Scholar 

  46. Faybik P, Hetz H, Krenn CG et al. (2003) Liver support in fulminant liver failure after hemorrhagic shock. Wien Klin Wochenschr 115:595–598

    PubMed  Google Scholar 

  47. Ganger DR, Klapman JB, McDonald V et al. (1999) Transjugular intrahepatic portosystemic shunt (TIPS) for Budd-Chiari syndrome or portal vein thrombosis: review of indications and problems. Am J Gastroenterol 94:559–561

    PubMed  Google Scholar 

  48. Ginès A, Fernandez-Esparrach G, Monescillo A et al. (1996) Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis. Gastroenterology 111:1002–1010

    PubMed  Google Scholar 

  49. Ginès P, Ortega R, Uriz J et al. (2001) Effect of terlipressin administration with and without albumin in hepatorenale syndrome (HRS). A phase-II study. Hepatology 34:186A

    Google Scholar 

  50. Guevara M, Ginès P, Bandi JC et al. (1998) Transjugular intrahepatic portosystemic shunt in hepatorenale syndrome: effects on renal function and vasoactive systems. Hepatology 28:416–422

    CAS  PubMed  Google Scholar 

  51. Häusinger D (1983) Hepatocyte heterogeneity in glutamine and ammonia metabolism and the role of an intercellular glutamine cycle during ureogenesis in perfused rat liver. Eur J Biochem 133:269–275

    PubMed  Google Scholar 

  52. Hawker F (1991) Liver dysfunction in critical illness. Anaesth Intensive Care 19:165–181

    CAS  PubMed  Google Scholar 

  53. Henrion J, Colin L, Schmitz A, Schapira M, Heller FR (1993) Ischemic hepatitis in cirrhosis. Rare but lethal. J Clin Gastroenterol 16:35–39

    CAS  PubMed  Google Scholar 

  54. Hepner GW, Vesell ES (1975) Quantitative assessment of hepatic function by breath analysis after oral administration of (14C)aminopyrine. Ann Intern Med 83:632–638

    CAS  PubMed  Google Scholar 

  55. Hetz H, Faybik P, Baker A, Gruenberger T, Neumayer C, Steltzer H (2002) Case report: early MARS-treatment for liver dysfunction following complicated hemihepatectomy (abstract). 4th Symposium on Albumin Dialysis in Liver Disease, Rostock-Warnemünde

    Google Scholar 

  56. Holt S, Goodier D, Marley R et al. (1999) Improvement in renal function in hepatorenale syndrome with N-acetylcysteine. Lancet 353:294–295

    CAS  PubMed  Google Scholar 

  57. Hu QG, Zheng QC (2003) The influence of enteral nutrition in postoperative patients with poor liver function. World J Gastroenterol 9:843–846

    CAS  PubMed  Google Scholar 

  58. Hughes RD, Pucknell A, Routley D, Langley PG, Wendon JA, Williams R (1994) Evaluation of the BioLogic DT sorbent-suspension dialyser in patients with fulminant hepatic failure. Int J Artif Organs 17:657–662

    CAS  PubMed  Google Scholar 

  59. Iwasa M, Matsumara K, Watanabe Y et al. (2003) Improvement of regional blood flow after treatment with branched-chain amino acid solutions in patients with cirrhosis. Eur J Gastroenterol Hepatol 15:733–737

    Article  CAS  PubMed  Google Scholar 

  60. Jaeck D, Boudjema K, Audet M, Chenard-Neu MP, Meyer C, Nakano H, Wolf P (2002) Auxiliary partial orthotopic liver transplantation (APOLT) in the treatment of acute liver failure. J Gastroenterol 37 [Suppl 13]:88–91

    Google Scholar 

  61. Jalan R, Damink SW, Deutz NE, Lee A, Hayes PC (1999) Moderate hypothermia for uncontrolled intracranial hypertension in acute liver failure. Lancet 354:1164–1168

    CAS  PubMed  Google Scholar 

  62. Jalan R, Olde Damink SWM, Deutz NEP et al. (2003) Moderate hypothermia prevents cerebral hyperemia and increase in intracranial pressure in patients undergoing liver transplantation for acute liver failure. Transplantation 75:2034–2039

    Article  PubMed  Google Scholar 

  63. Jonge E de, Schultz MJ, Spanjaard L, Bossuyt PMM, Vroom M, Dankert J, Kesecioglu J (2003) Effects of selective decontamination of digestive tract on mortality and acquisition of resistant bacteria in intensive care: a randomised controlled trial. Lancet 362:1011–1016

    Article  PubMed  Google Scholar 

  64. Jungermann K (1987) Regulation von Stoffwechsel und Hämodynamik der Leber durch die hepatischen Nerven. Z Gastroenterol 25 [Suppl 1]:44–54

    Google Scholar 

  65. Jungermann K, Katz N (1989) Functional specialization of different hepatocyte populations. Physiol Rev 69:708–764

    CAS  PubMed  Google Scholar 

  66. Kamohara Y, Rozga J, Demetriou AA (1998) Artificial liver: review and Cedars-Sinai experience. J Hepatobiliary Pancreat Surg 5:273–285

    Article  CAS  PubMed  Google Scholar 

  67. Kaplan MM (1972) Alkaline phosphatase. Gastroenterology 1972:452–468

    Google Scholar 

  68. Kearns PJ, Young H, Garcia G et al. (1992) Accelerated improvement of alcoholic liver disease with enteral nutrition. Gastroenterology 102:200–205

    CAS  PubMed  Google Scholar 

  69. Kellersmann R, Gassel HJ, Bühler C, Thiede A, Timmermann W (2002) Application of molecular adsorbent recirculating system in patients with severe liver failure after hepatic resection or transplantation: initial single-centre experiences. Liver 22 [Suppl 2]:56–58

  70. Kholoussy AM, Pollack D, Matsumoto T (1984) Prognostic significance of indocyanine green clearance in critically ill surgical patients. Crit Care Med 12:115–116

    CAS  PubMed  Google Scholar 

  71. Kiefer P, Tugtekin I, Wiedeck H et al. (2001) Hepato-splanchnic metabolic effects of the stable prostacyclin analogue iloprost in patients with septic shock. Intensive Care Med 27:1179–1186

    Article  Google Scholar 

  72. Kimura S, Yoshioka T, Shibuya M, Sakano T, Tanaka R, Matsuyama S (2001) Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival. Crit Care Med 29:1159–1163

    CAS  PubMed  Google Scholar 

  73. Kircheis G, Nilius R, Held C et al. (1997) Therapeutic efficacy of L-ornithine-L-aspartate infusions in patients with cirrhosis and hepatic encephalopathy: results of a placebo-controlled, double-blind study. Hepatology 25:1351–1360

    CAS  PubMed  Google Scholar 

  74. Knell AJ, Dukes DC (1976) Dialysis procedures in acute liver coma. Lancet 2:402–403

    CAS  PubMed  Google Scholar 

  75. Kortgen A, Pistorius G, Fischinger J, Kuhlmann M, Becker C, Bauer M (2003) Non-invasive monitoring of indocyanine green plasma disappearance rate in the treatment of primary graft dysfunction by MARS (abstract). 5th Symposium on Albumin Dialysis in Liver Disease, Rostock

  76. Krenn CG, Schafer B, Berlakovich GA, Steininger R, Steltzer H, Spiss CK (1998) Detection of graft nonfunction after liver transplantation by assessment of indocyanine green kinetics. Anesth Analg 87:34–36

    Google Scholar 

  77. Krueger WA, Lenhart FP, Neeser G et al. (2002) Influence of combined intravenous and topical antibiotic prophylaxis on the incidence of infections, organ dysfunctions, and mortality in critically ill surgical patients: a prospective, stratified, randomised, double-blind, placebo-controlled clinical trial. Am J Respir Crit Care Med 166:1029–1037

    Google Scholar 

  78. Lau H, Man K, Fan ST, Yu WC, Lo CM, Wong J (1997) Evaluation of preoperative hepatic function in patients with hepatocellular carcinoma undergoing hepatectomy. Br J Surg 84:1255–1259

    Article  CAS  PubMed  Google Scholar 

  79. Lautt WW, Greenway CV (1987) Conceptional review of the hepatic vascular bed. Hepatology 7:952–963

    CAS  PubMed  Google Scholar 

  80. Lédinghen V de, Beau P, Mannant P-R, Borderie C, Ripault M-P, Silvain C, Beauchant M (1997) Early feeding or enteral nutrition in patients with cirrhosis after bleeding from esophageal varices? A randomised controlled study. Dig Dis Sci 42:536–541

    PubMed  Google Scholar 

  81. Lehmann C, Taymoorian K, Wauer H, Krausch D, Birnbaum J, Kox WJ (2000) Effects of stable prostacyclin analogue iloprost on the plasma disappearance rate of indocyanine green in human septic shock. Intensive Care Med 26:1557–1560

    CAS  PubMed  Google Scholar 

  82. Li AP, Rasmussen A, Xu L, Kaminski DL (1995) Rifampicin induction of lidocaine metabolism in cultured human hepatocytes. Pharmacol Exp Ther 274:673–677

    CAS  Google Scholar 

  83. Liu JP, Gluud LL, Als-Nielsen B, Gluud C (2004) Artificial and bioartificial support systems for liver failure (Cochrane Review). In: The Cochrane Library, Issue I. Wiley & Sons, Chichester

  84. Macdougall BR, Bailey RJ, Williams R (1977) H2-receptor antagonists and antacids in the prevention of acute gastrointestinal haemorrhage in fulminant hepatic failure. Two controlled trials. Lancet 1:617–619

    Article  CAS  PubMed  Google Scholar 

  85. Marzi I (1994) Bedeutung der Leber für den Verlauf des SIRS nach Schock, Trauma und bei Sepsis. Anasthesiol Intensivmed Notfallmed Schmerzther 29:41–46

    CAS  PubMed  Google Scholar 

  86. Maynard ND, Bihari DJ, Dalton RN, Beale R, Smithies MN, Mason RC (1997) Liver function and splanchnic ischemia in critically ill patients. Chest 111:180–187

    CAS  PubMed  Google Scholar 

  87. McCuskey RS, Reilly FD (1993) Hepatic microvasculature: dynamic structure and its regulation. Semin Liver Dis 13:1–12

    CAS  PubMed  Google Scholar 

  88. Meier-Hellmann A, Sakka SG, Reinhart K (2000) Catecholamines and splanchnic perfusion. Schweiz Med Wochenschr 130:1942–1947

    CAS  PubMed  Google Scholar 

  89. Merkel C, Bolognesi M, Bellon S et al. (1992) Aminopyrine breath test in the prognostic evaluation of patients with cirrhosis. Gut 33:836–842

    CAS  PubMed  Google Scholar 

  90. Millis JM, Cronin DC, Johnson R, Conjeevaram H, Conlin C, Trevino S, Maguire P (2002) Initial experience with the modified extracorporeal liver-assist device for patients with fulminant hepatic failure: system modifications and clinical impact. Transplantation 74:1735–1746

    PubMed  Google Scholar 

  91. Mitzner W (1974) Effect of portal venous pressure on portal venous inflow and splanchnic resistance. J Appl Physiol 37:706–711

    CAS  PubMed  Google Scholar 

  92. Mitzner SR, Stange J, Klammt S et al. (2000) Improvement of hepatorenale syndrome with extracorporeal albumin dialysis MARS: results of a prospective, randomised, controlled clinical trial. Liver Transpl 6:277–286

    CAS  Google Scholar 

  93. Mitzner SR, Stange J, Klammt S, Peszynski P, Schmidt R (2001) Albumin dialysis using the molecular adsorbent recirculating system. Curr Opin Nephrol Hypertens 10:777–783

    Article  CAS  PubMed  Google Scholar 

  94. Molnar Z, Shearer E, Lowe D (1999) N-acetylcysteine treatment to prevent the progression of multisystem organ failure: a prospective, randomised, placebo-controlled study. Crit Care Med 27:1100–1104

    Google Scholar 

  95. Moureau R, Durand F, Poynard T et al. (2002) Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology 122:923–930

    PubMed  Google Scholar 

  96. Murphy N, Auzinger G, Bernel W, Wendon J (2004) The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology 39:464–470

    Article  PubMed  Google Scholar 

  97. Nonami T, Nakao A, Kurokawa T, Inagaki H, Matsushita Y, Sakamoto J, Takagi H (1999) Blood loss and ICG clearance as best prognostic markers of post-hepatectomy liver failure. Hepatogastroenterology 46:1669–1672

    CAS  PubMed  Google Scholar 

  98. Núñez-Martinez O, Cruz G de la, Diego A de et al. (2003) Liver transplantation for fulminant and subfulminant hepatic failure. Transplant Proc 35:1855–1856

    Article  PubMed  Google Scholar 

  99. O’Grady JG, Gimson AES, O’Brien CJO, Pucknell A, Hughes RD, Williams R (1988) Controlled trials of charcoal hemoperfusion and prognostic factors in fulminant hepatic failure. Gastroenterology 94:1186–1192

    Google Scholar 

  100. O’Grady J, Alexander G, Hayllar K, Williams R (1989) Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 97:439–445

    CAS  PubMed  Google Scholar 

  101. Oellerich M, Raude E, Burdelski M et al. (1987) Monoethylglycinexylidide formation kinetics: a novel approach to assessment of liver function. J Clin Chem Clin Biochem 25:845–853

    CAS  PubMed  Google Scholar 

  102. Oellerich M, Burdelski M, Lautz HU et al. (1991) Assessment of pretransplant prognosis in patients with cirrhosis. Transplantation 51:801–806

    CAS  PubMed  Google Scholar 

  103. Oellerich M, Schutz E, Polzien F, Ringe B, Armstrong VW, Hartmann H, Burdelski M (1994) Influence of gender on the monoethylglycinexylidide test in normal subjects and liver donors. Ther Drug Monit 16:225–231

    CAS  PubMed  Google Scholar 

  104. Opitz T, Buchwald AB, Lorf T, Awuah D, Ramadori G, Nolte W (2003) The transjugular intrahepatic portosystemic stent-shunt (TIPS) as rescue therapy for complete Budd-Chiari syndrome and portal vein thrombosis. Z Gastroenterol 41:413–418

    CAS  PubMed  Google Scholar 

  105. Pannen BHJ, Robotham JL (1995) The acute phase response. New Horiz 3:183–197

    CAS  PubMed  Google Scholar 

  106. Pascher A, Sauer IM, Hammer C, Gerlach JC, Neuhaus P (2002) Extracorporeal liver perfusion as hepatic assist in acute liver failure: a review of world experience. Xenotransplantation 9:309–324

    Article  PubMed  Google Scholar 

  107. Paxian M, Rensing H, Geckeis K, Bauer I, Kubulus D, Spahn DR, Bauer M (2003) Perflubron emulsion in prolonged hemorrhagic shock: influence on hepatocellular energy metabolism and oxygen-dependent gene expression. Anesthesiology 98:1391–1399

    Article  CAS  PubMed  Google Scholar 

  108. Perelló A, García-Pagán JC, Gilabert R et al. (2002) TIPS is a useful long-term derivative therapy for patients with Budd-Chiari syndrome uncontrolled by medical therapy. Hepatology 35:132–139

    Article  PubMed  Google Scholar 

  109. Plauth M, Weimann A, Holm E, Müller MJ (1999) Leitlinien der GASL zur Ernährung bei Leberkrankheiten und Lebertransplantation. Z Gastroenterol 37:301–312

    CAS  PubMed  Google Scholar 

  110. Plauth M, Schütz ET, Bechstein W-O, Neuhaus P, Lochs H (2000) Ernährung beim akuten Leberversagen—Ergebnisse einer europäischen Umfrage. Z Gastroenterol 39:133

    Google Scholar 

  111. Plauth M, Ferenci P, Holm E, Dahl S vom, Kondrup J, Müller MJ, Nolte W (2003) DGEM-Leitlinie Enterale Ernährung: Hepatologie. Aktuel Ernaehr Med 28 [Suppl 1]:S87–92

  112. Rank N, Michel C, Haertel C, Lenhart A, Welte M, Meier-Hellmann A, Spies C (2000) N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: results of a prospective, randomised, double-blind study. Crit Care Med 28:3799–3807

    PubMed  Google Scholar 

  113. Reichling JJ, Kaplan MM (1988) Clinical use of serum enzymes in liver disease. Dig Dis Sci 33:1601–1614

    CAS  PubMed  Google Scholar 

  114. Reinhart K, Spies CD, Meier-Hellmann A, et al. (1995) N-acetylcysteine preserves oxygen consumption and gastric mucosal pH during hyperoxic ventilation. Am J Respir Crit Care Med 151:773–779

    PubMed  Google Scholar 

  115. Rensing H, Bauer M (2001) Multiorganversagen. Mechanismen, klinische Manifestationen und Therapiestrategien. Anaesthesist 50:819–841

    Article  CAS  PubMed  Google Scholar 

  116. Rensing H, Bauer I, Zhang JX et al. (2002) Endothelin-1 and heme oxygenase-1 as modulators of sinusoidal tone in the stress-exposed rat liver. Hepatology 36:1453–1465

    Article  CAS  PubMed  Google Scholar 

  117. Revelly JP, Ayuse T, Brienza N, Robotham JL (1995) Dysregulation of the veno-arterial response in the superior mesenteric artery during endotoxic shock. Crit Care Med 23:1519–1527

    Google Scholar 

  118. Rifai K, Bahr MJ (2003) Akutes Leberversagen. Internist 44:585–598

    CAS  PubMed  Google Scholar 

  119. Rifai K, Ernst T, Kretschmer U et al. (2003) Prometheus—a new extracorporeal system for the treatment of liver failure. J Hepatol 39:984–990

    Article  CAS  PubMed  Google Scholar 

  120. Rimola A, Bory F, Teres J, Perez-Ayuso RM, Arroyo V, Rodes J (1985) Oral, nonabsorbable antibiotics prevent infection in cirrhotics with gastrointestinal hemorrhage. Hepatology 5:463–467

    CAS  PubMed  Google Scholar 

  121. Rolando N, Wade JJ, Stangou A et al. (1996) Prospective study comparing the efficacy of prophylactic parenteral antimicrobials, with or without enteral decontamination, in patients with acute liver failure. Liver Transpl Surg 2:8–13

    CAS  PubMed  Google Scholar 

  122. Sakka SG, Reinhart K, Meier-Hellmann A (2002) Prognostic value of the indocyanine green plasma disappearance rate in critically ill patients. Chest 122:1715–1720

    Article  PubMed  Google Scholar 

  123. Salmeron JM, Tito L, Rimola A et al. (1992) Selective intestinal decontamination in the prevention of bacterial infection in patients with acute liver failure. J Hepatol 14:280–285

    CAS  PubMed  Google Scholar 

  124. Samuel D, Ichai P, Feray C et al. (2002) Neurological improvement during bioartificial liver sessions in patients with acute liver failure awaiting transplantation. Transplantation 73:257–264

    Google Scholar 

  125. Saner FH, Frühauf NR, Schäfers RF, Lang H, Malagó M, Broelsch CE (2002) Terlipressin plus hydroxyethyl starch infusion: an effective treatment for hepatorenale syndrome. Eur J Gastroenterol Hepatol 15:925–927

    Article  Google Scholar 

  126. Sauer IM, Kardassis D, Zeilinger K et al. (2003) Clinical extracorporeal hybrid liver support—phase I study with primary porcine liver cells. Xenotransplantation 10:460–469

    Article  CAS  PubMed  Google Scholar 

  127. Schneeweiss B, Pammer J, Ratheiser K et al. (1993) Energy metabolism in acute hepatic failure. Gastroenterology 105:1515–1521

    CAS  PubMed  Google Scholar 

  128. Schmidt LE, Sorensen VR, Svendson LB, Hansen BA, Larsen FS (2001) Hemodynamic changes during a single treatment with the molecular adsorbent recirculating system in patients with acute-on-chronic liver failure. Liver Transpl 7:1034–1039

    Article  CAS  PubMed  Google Scholar 

  129. Schoeniger LO, Reilly P, Bulkley GB, Buchman TG (1992) Molecular biology of circulatory shock V. Heat shock gene expression excludes hepatic acute phase gene expression following resuscitation from hemorrhagic shock. Surgery 112:355–363

    CAS  Google Scholar 

  130. Schroter J, Wandel C, Bohrer H, Schmidt H, Bottiger BW, Martin E (1995) Lignocaine metabolite formation: an indicator for liver dysfunction and predictor of survival in surgical intensive care patients. Anaesthesia 50:850–854

    PubMed  Google Scholar 

  131. Shakil AO, Kramer D, Mazariegos GV, Fung JJ, Rakela J (2000) Acute liver failure: clinical featrures, outcome analysis, and applicability of prognostic criteria. Liver Transpl 6:163–169

    CAS  PubMed  Google Scholar 

  132. Shawcross DL, Davies NA, Mookerjee RP, Hayes PC, Williams R, Lee A, Jalan R (2004) Worsening of cerebral hyperemia by the administration of terlipressin in acute liver failure with severe encephalopathy. Hepatology 39:471–475

    Article  PubMed  Google Scholar 

  133. Shi Y, He J, Chen S, Zhang L, Yang X, Wang Z, Wang M (2002) MARS: optimistic therapy method in fulminant hepatic failure secondary to cytotoxic mushroom poisoning—a case report. Liver 22 [Suppl 2]:78–80

  134. Siegel JH, Goodzari S, Guadelupi P et al. (1993) The host defense to trauma and sepsis: multiple organ failure as a manifestation of host defense failure disease. In: Schlag G, Redl H (Hrsg) Pathophysiology of shock, sepsis, and organ failure. Springer, Berlin Heidelberg New York, S 626–664

  135. Soares-Weiser K, Brezis M, Tur-Kaspa R, Leibovici L (2004) Antibiotic prophylaxis for cirrhotic patients with gastrointestinal bleeding (Cochrane review). In: The Cochrane Library, Issue 1, 2004. Wiley & Sons, Chichester

  136. Sola-Vera J, Minana J, Ricart E et al. (2003) Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites. Hepatology 37:1147–1153

    Article  CAS  PubMed  Google Scholar 

  137. Solanki P, Chawla A, Garg R, Gupta R, Jain M, Sarin SK (2003) Beneficial effects of terlipressin in hepatorenale syndrome: a prospective, randomised placebo-controlled clinical trial. J Gastroenterol Hepatol 18:152–156

    Article  CAS  PubMed  Google Scholar 

  138. Sort P, Navasa M, Arroyo V et al. (1999) Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med 341:403–409

    CAS  PubMed  Google Scholar 

  139. Staedt U, Leweling H, Gladisch R, Kortsik C, Hagmuller E, Holm E (1993) Effects of ornithine aspartate on plasma ammonia and plasma amino acids in patients with cirrhosis. A double-blind, randomised study using a four-fold crossover design. J Hepatol 19:424–430

    CAS  PubMed  Google Scholar 

  140. Stange J, Mitzner S, Klammt S et al. (2001) New extracorporeal liver support for chronic liver disease complicated by cholestasis—results of a prospective controlled randomized two-center trial (abstract). J Hepatol 34 [Suppl 1]:45

  141. Steiner C, Mitzner S (2002) Experiences with MARS liver support therapy in liver failure: analysis of 176 patients of the international MARS registry. Liver 22 [Suppl 2]:20–25

  142. Sterling RK, Luketic VA, Sanyal AJ, Shiffman ML (1998) Treatment of fulminant hepatic failure with intravenous prostaglandin E1. Liver Transpl Surg 4:424–431

    CAS  PubMed  Google Scholar 

  143. Stockmann HB, Hiemstra CA, Marquet RL, Ijzermans JNM (2000) Extracorporeal perfusion for the treatment of acute liver failure. Ann Surg 231:460–470

    Article  CAS  PubMed  Google Scholar 

  144. Takala J (1996) Determinants of splanchnic blood flow. Br J Anaesth 77:50–58

    CAS  PubMed  Google Scholar 

  145. Träger K, Matejovic M, Zülke C et al. (2000) Hepatic O2 exchange and liver energy metabolism in hyperdynamic porcine endotoxemia: effects of iloprost. Intensive Care Med 26:1531–1539

    PubMed  Google Scholar 

  146. Uemoto S, Inomata Y, Sakurai T et al. (2000) Living donor liver transplantation for fulminant hepatic failure. Transplantation 70:152–157

    CAS  PubMed  Google Scholar 

  147. Uriz J, Gines P, Cardenas A et al. (2000) Terlipressin plus albumin infusion: an effective and safe therapy of hepatorenale syndrome. J Hepatol 33:43–48

    Article  CAS  PubMed  Google Scholar 

  148. Vincent JL, Angus DC, Artigas A et al. (2003) Effects of drotrecogin alfa (activated) on organ dysfunction in the PROWESS trial. Crit Care Med 31:834–840

    Article  CAS  PubMed  Google Scholar 

  149. Walsh TS, Hopton P, Philips BJ, Mackenzie SJ, Lee A (1998) The effect of N-acetylcysteine on oxygen transport and uptake in patients with fulminant hepatic failure. Hepatology 27:1332–1340

    CAS  PubMed  Google Scholar 

  150. Wang K, Deutschman CS, Clemens MG, Maio A de (1995) Reciprocal expression of phosphoenolpyruvate carboxykinase and acute phase genes during acute inflammation. Shock 3:204–209

    CAS  PubMed  Google Scholar 

  151. Wang JS, Backman JT, Wen X, Taavitsainen P, Neuvonen PJ, Kivisto KT (1999) Fluvoxamine is a more potent inhibitor of lidocaine metabolism than ketoconazole and erythromycin in vitro. Pharmacol Toxicol 85:201–205

    CAS  PubMed  Google Scholar 

  152. Watanabe FD, Mullon CJP, Hewitt WR et al. (1997) Clinical experience with a bioartificial liver in the treatment of severe liver failure: a phase I clinical trial. Ann Surg 225:484–494

    Article  CAS  PubMed  Google Scholar 

  153. Wesslau C, Krüger R, May G (1994) Clinical investigations using indocyanine green clearance for evaluation of liver function in organ donors. Transplantology 5:7–9

    Google Scholar 

  154. Williams R, Riordan SM (2000) Acute liver failure: established and putative hepatitis viruses and therapeutic implications. J Gastroenterol Hepatol 15:G17–25

    Article  PubMed  Google Scholar 

  155. Williams RS, Alisa AA, Karani JB, Muiesan P, Rela SM, Heaton ND (2003) Adult-to-adult living donor liver transplant: UK experience. Eur J Gastroenterol Hepatol 15:7–14

    Article  PubMed  Google Scholar 

  156. Wolff M, Kalff JC, Schwarz NT, Lauschke H, Minor T, Tolba RH, Hirner A (2003) Lebertransplantation in Deutschland. Zentralbl Chir 128:831–841

    CAS  PubMed  Google Scholar 

  157. Zardi EM, Picardi A, Ambrosino G, Serio A, Costantino S, Dobrina A (2003) Hemodynamic effects of a prostacyclin analog (iloprost) on portal flow velocity and volume and visceral artery circulation in patients with lower limb arteriopathy. Ultrasound Med Biol 29:209–213

    Article  PubMed  Google Scholar 

  158. Zieniewicz K, Skwarek A, Nyckowski P et al. (2003) Comparison of the results of liver transplantation for elective versus urgent indications. Transplant Proc 35:2262–2264

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Affiliations

  1. Klinik für Anaesthesiologie und Intensivmedizin, Universität des Saarlandes

    M. Bauer & A. Kortgen

  2. Klinik für Anaesthesiologie und Intensivtherapie, Friedrich-Schiller-Universität, Jena

    M. Bauer & M. Paxian

  3. Klinik für Anästhesiologie und Intensivmedizin, Universität des Saarlandes, Kirrberger Straße/Geb. 57, 66421, Homburg/Saar

    M. Bauer

Authors
  1. M. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Paxian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Kortgen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Bauer.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Bauer, M., Paxian, M. & Kortgen, A. Akutes Leberversagen. Anaesthesist 53, 511–530 (2004). https://doi.org/10.1007/s00101-004-0682-4

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00101-004-0682-4

Schlüsselwörter

  • Leberversagen
  • Akut
  • Akut-auf-chronisch
  • Hepatische Enzephalopathie
  • Hepatorenales Syndrom
  • Indozyaningrün
  • Extrakorporale Ersatzverfahren
  • Lebertransplantation
  • Leberdysfunktion

Keywords

  • Liver failure
  • Acute
  • Acute-on-chronic
  • Hepatic encephalopathy
  • Hepatorenal syndrome
  • Indocyanine green
  • Extracorporeal support
  • Liver transplantation
  • Liver dysfunction