[Treatment of Fulminant Hepatic Failure - Myth and Facts]

Acute liver failure (ALF) refers to primary damage to a previously healthy liver. It is a rare disease with an incidence of about 200-500 cases/year in Germany. The liver can recover to restitutio ad integrum or lead to death in no time despite best medical treatment. Due to the rarity and potentially dramatic clinical course, patients with acute liver failure should be promptly referred to a special liver unit that can provide a liver transplantation as rescue treatment.The ALF should be strictly distinguished from "acute-on-chronic" liver failure (ACLF), which may show a similar clinical course but does not qualify for a high-urgency listing and transplantation.The reason for an ALF remains unknown in up to 20 % of cases. Hepatotropic virus (HAV, HBV and HEV) are the most common causative agents in Africa and Asia, while in North America and Northern and Central Europe, more drug-related liver failure is more frequent. Among drugs paracetamol and phenprocoumone are the leading cause for ALF. However, there are a couple of dietary supplements, herbs and mushroom poisoning that cause ALF.Other reasons are ischemic hepatitis and autoimmune hepatitis.