Acute liver failure: a life-threatening disease

An estimated 200 to 500 patients develop life-threatening acute liver failure (ALF) in Germany each year. Only sparse data are currently available on the epidemiology and causes of this condition and on potential treatments for it. This article summarizes our current knowledge of the causes, clinical course, and treatment of ALF.

We selectively reviewed the pertinent current literature on ALF from Germany and abroad.

A shift is currently taking place in Germany with respect to the predominant causes of ALF: The leading cause was formerly acute viral hepatitis, but now more cases of ALF are induced by toxic substances, while there is also a growing incidence of cryptogenic subacute ALF. Precise epidemiological data are still lacking. Scoring -systems for the assessment of ALF should take account of hepatic function, the regenerative capacity of the liver, the extent of existing extrahepatic complications, and the risk that further ones will develop. The mortality from ALF has been reduced through improved specific treatment for certain etiological types of ALF, the introduction of liver transplantation, and progress in intensive care medicine. The optimal treatment of ALF patients requires close collaboration among specialists in all of the involved clinical disciplines, as well as between peripheral hospitals and transplantation centers.

Precise epidemiological data on ALF are still lacking in Germany, as are prospective, randomized trials of treatments for it. It is nonetheless clear that progress has been made in its diagnosis and treatment.