Management of acute liver failure-an updated literature review

Acute liver failure (ALF) is a rare but life-threatening condition marked by rapid hepatic dysfunction, coagulopathy and encephalopathy in patients without prior liver disease. Common causes include drug-induced liver injury, viral hepatitis, and metabolic or autoimmune disorders. This review provides an updated overview of ALF's etiology, diagnosis, and management. Timely diagnosis and risk stratification using tools like the King's College Criteria and Model for End-Stage Liver Disease score are critical for guiding care. Early identification of etiology allows targeted treatments, such as N-acetylcysteine for acetaminophen toxicity or antivirals for hepatitis. Supportive care in specialized intensive care units, focused on hemodynamics, cerebral edema prevention, and metabolic stabilization, remains the cornerstone of management. Advances in extracorporeal liver support systems, such as molecular adsorbent recirculating systems and plasma exchange, offer promising bridges to recovery or liver transplantation - the definitive treatment for irreversible liver injury. Expanded donor criteria and improved allocation policies have enhanced transplantation access. Despite progress, ALF carries significant morbidity and mortality. Emerging therapies, including stem cell treatments and immunomodulatory agents, show potential to revolutionize care. This review emphasizes the need for a multidisciplinary approach and continued research to improve outcomes and refine therapeutic strategies.