Assessment of the Patient with Acute Liver Failure
Summary
Liver transplantation (LT) is an integral part of the management plan of patients with acute liver failure (ALF) and few patients are managed outside centers with active transplant programs. A fundamental issue is that prognosis is very variable in ALF and an understanding of the issues that determine prognosis is essential for the appropriate delivery of LT. Volumetric assessment of the liver and liver biopsy findings may also be of prognostic value. The use of LT in ALF drove the need for prognostic models that would highlight a poor prognosis at the earliest possible opportunity. Auxiliary orthotopic transplantation has been used in ALF as a bridge to survival without the need for life-long immunosuppression. Severe neurologic and cardiovascular complications stabilize after hepatectomy and patients with high inotrope requirements or severe cerebral edema are unsuitable for auxiliary LT.