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Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 28, 2016; 22(4): 1523-1531
Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1523
Liver transplantation in acute liver failure: A challenging scenario
Manuel Mendizabal, Marcelo Oscar Silva
Manuel Mendizabal, Marcelo Oscar Silva, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Pilar B1629AHJ, Argentina
Author contributions: Mendizabal M designed the outline, selected the articles for review, and wrote the manuscript; Silva MO approved the manuscript and rewrote some sections of the text.
Conflict-of-interest statement: The authors have no conflict of interest to declare.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manuel Mendizabal, MD, Staff Hepatologist, Hepatology and Liver Transplant Unit, Hospital Universitario Austral, Avenida Juan D. Perón 1500, Pilar B1629AHJ, Argentina. mmendiza@cas.austral.edu.ar
Telephone: +54-230-4482884 Fax: +54-230-4482236
Received: April 28, 2015
Peer-review started: May 5, 2015
First decision: September 29, 2015
Revised: October 14, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: January 28, 2016
Processing time: 267 Days and 14.5 Hours
Abstract

Acute liver failure is a critical medical condition defined as rapid development of hepatic dysfunction associated with encephalopathy. The prognosis in these patients is highly variable and depends on the etiology, interval between jaundice and encephalopathy, age, and the degree of coagulopathy. Determining the prognosis for this population is vital. Unfortunately, prognostic models with both high sensitivity and specificity for prediction of death have not been developed. Liver transplantation has dramatically improved survival in patients with acute liver failure. Still, 25% to 45% of patients will survive with medical treatment. The identification of patients who will eventually require liver transplantation should be carefully addressed through the combination of current prognostic models and continuous medical assessment. The concerns of inaccurate selection for transplantation are significant, exposing the recipient to a complex surgery and lifelong immunosuppression. In this challenging scenario, where organ shortage remains one of the main problems, alternatives to conventional orthotopic liver transplantation, such as living-donor liver transplantation, auxiliary liver transplant, and ABO-incompatible grafts, should be explored. Although overall outcomes after liver transplantation for acute liver failure are improving, they are not yet comparable to elective transplantation.

Keywords: Encephalopathy; Fulminant hepatic failure; Liver transplantation; Outcome; Prognostic score

Core tip: Acute liver failure is the most dramatic clinical situation in which liver transplantation is performed. In this manuscript, we describe the timing and benefits of this procedure by analyzing the different prognostic scores and surgical techniques.