Acute liver failure and liver transplantation

Area of Science:

• Hepatology
• Transplant Surgery
• Critical Care Medicine

Background:

• Acute liver failure (ALF) presents with coagulopathy and hepatic encephalopathy in patients without prior liver disease.
• High mortality rates (over 80%) are associated with ALF without liver transplantation.
• Liver transplantation has markedly improved survival rates for ALF patients over the past two decades.

Purpose of the Study:

• To review the impact of liver transplantation on survival rates in patients with acute liver failure.
• To highlight the role and outcomes of living donor liver transplantation (LDLT) for ALF, particularly in regions with limited deceased donor organ availability.

Main Methods:

• Review of recent large studies and reports on liver transplantation for ALF.
• Analysis of patient survival rates following deceased donor liver transplantation (DDLT) and LDLT.

Main Results:

• Patient survival rates after DDLT for ALF are approximately 80% at 1 year, 70% at 5 years, and 65% at 10 years in Western countries.
• Overall survival rates for adult ALF patients undergoing LDLT range from 60% to 90% in regions where it has evolved.
• LDLT has become an established treatment for ALF in areas with restricted deceased donor organ access.

Conclusions:

• Liver transplantation significantly enhances survival for patients with acute liver failure.
• Living donor liver transplantation is a viable and effective treatment option for ALF, especially in organ-scarce environments.
• Despite ongoing discussions on graft specifics and ethics, LDLT plays a vital role in managing ALF globally.