[Acute liver failure]

Acute liver failure represents a serious life-threatening event comparable to acute heart failure with cardiogenic shock or acute renal failure. Underlying acute liver diseases leading to hepatic failure differ between different geographic regions and in their incidence rates. In Europe etiological agents like viruses, drugs and toxins predominate over other much rarer causes. The different noxious agents lead to hepatocellular necrosis and/or apoptosis with loss of liver cell specific functions subsequent to a fall of functioning hepatocytes below a critical number. The syndrome is clinically characterized by the rapid onset of hepatic encephalopathy within 7 days after a first manifestation of liver disease (fulminant liver disease). Liver failure in patients with preexisting chronic liver disease is largely defined by the time which elapses between the occurrence of jaundice and encephalopathy (hyperacute, acute, subacute liver failure). The acute loss of liver specific functions is accompanied by a number of severe life-threatening complications like cerebral edema, circulatory failure, infections, renal failure and defective coagulation. Management of patients with fulminant liver disease requires a profound knowledge of hepatology and intensive care medicine. A close cooperation with a liver transplant unit is an absolute prerequisite for successful therapy. Permanent or temporary auxiliary liver replacement by a healthy human liver allows for a survival of 60 to 70% of patients selected for such a transplant procedure. Progress has been made in the temporary substitution of specific liver cell functions bridging the time period between liver failure and resumption of hepatocellular functions or availability of a donor liver. Different artificial livers have been designed and introduced into clinical trials. However, further evaluation is urgently needed.