Liver transplantation in acute liver failure

Area of Science:

• Hepatology
• Transplantation Surgery
• Critical Care Medicine

Background:

• Acute liver failure (ALF) necessitates liver transplantation for poor prognosis cases.
• Orthotopic liver transplantation (OLT) is the primary treatment, but contraindications exist.
• Predictive scores for early mortality aim to prevent futile transplantations but lack sufficient reliability.

Purpose of the Study:

• To review alternative liver transplantation techniques for ALF.
• To discuss criteria for selecting appropriate transplant strategies.
• To highlight survival outcomes and recent improvements in ALF liver transplantation.

Main Methods:

• Review of current literature on liver transplantation for ALF.
• Analysis of alternative surgical approaches beyond standard OLT.
• Examination of survival data and prognostic factors.

Main Results:

• Alternative techniques include auxiliary, two-stage, ABO-incompatible, and living-donor liver transplantation.
• Patient selection is critical, considering medical comorbidities and clinical stability.
• Overall 1-year survival rates are 79% (Europe) and 84% (US); 5-year rates are 72% (Europe) and 73% (US).

Conclusions:

• Liver transplantation survival rates for ALF have significantly improved.
• Careful selection of patients and appropriate surgical techniques are vital for successful outcomes.
• ABO-incompatible transplantation, despite immunosuppressive advances, remains an exception requiring specific criteria.