Acute liver failure

Acute liver failure (ALF) is an uncommon clinical syndrome resulting from rapid loss of hepatocyte function, affecting only an estimated 2000 patients annually in the USA. Since 1998, the Acute Liver Failure Study Group, sponsored by the US National Institutes of Health, has utilized a multicenter network approach to gather detailed clinical data and biosamples from 3500 patients at more than 30 US tertiary-care medical centers. This chapter covers in detail the history, epidemiology, pathogenesis, and clinical management of this interesting condition, as well as some future considerations. The mortality due to ALF recorded in small case series in the pretransplant era was extremely high, often exceeding 90%. The causes of death typically include multiorgan failure, hemorrhage, infection, and cerebral edema. Fortunately, these dire outcomes have diminished somewhat due to improvement in recognition and management of ALF over the past 50 years, as well as the availability of liver transplantation.