Management of acute liver failure-an updated literature review

Abstract

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.

Keywords: Multidisciplinary management; Liver transplantation; Extracorporeal liver support; N-acetylcysteine; Model for End-Stage Liver Disease score; King’s College Criteria; Drug-induced liver injury; Coagulopathy; Hepatic encephalopathy; Acute liver failure

Core Tip: Acute liver failure (ALF) is a rapidly progressive and life-threatening condition that demands urgent recognition and intervention. This review highlights the latest insights into ALF’s diverse causes, diagnostic strategies, and management approaches. Emphasis is placed on early etiology identification, use of prognostic tools like King’s College Criteria and Model for End-Stage Liver Disease score, and timely initiation of targeted therapies. Advances in liver support systems and transplant accessibility have improved outcomes, yet ALF remains a critical challenge. A multidisciplinary, evidence-based approach is essential to optimize care and explore emerging treatments that may transform the future of ALF management.