Update on the management of acute liver failure.

PURPOSE OF REVIEW: The aim of this article is to provide the reader with an overview of established standards of care and to summarize important newer research findings in acute liver failure (ALF).

RECENT FINDINGS: New international guidelines are now in place with recommendations for medical care and nutritional support. Large-scale retrospective studies have confirmed the low level of bleeding complications observed, despite apparently severe coagulopathy on standard laboratory testing, and the improved survival seen with continuous rather than intermittent forms of renal replacement therapy. Advances in neurologic support include confirmation of the efficacy of control of hyperammonaemia using continuous haemofiltration, and of the utility of transcranial Doppler ultrasound as a screening modality for detection of cerebral oedema. Improvements in outcomes with medical treatment for some causes of ALF have resulted in need for new means of identification of patients who will benefit from liver transplantation.

SUMMARY: Best practice in the care of patients with ALF continues to evolve with ongoing improvement in survival. Survival in these patients is expected to improve further with refinement of medical supportive care and more accurate identification of transplant candidacy.