Liver transplantation in acute liver failure: Dilemmas and challenges

Core Tip

Core Tip: Liver transplantation (LT) is a lifesaving procedure for patients with acute liver failure (ALF). Its use, however, is constrained by the absence of reliable prognostic models that hampers the selection of transplant candidates in a timely and precise manner. The survival of medically treated ALF patients has increased over time, but the criteria for LT remain the same. No clear advantage of LT in acetaminophen-associated ALF appears to be present. The other problems associated with LT in ALF are diagnostic dilemmas, shortage of graft, waiting list contraindications, vaguely defined delisting criteria, pre-transplant assessment time limits, ethical concerns, and comparatively poor post-transplant outcomes. Therefore, there is a desperate need to establish accurate prognostic models and explore the roles of alternative therapies to enhance transplant-free survival and fill the gap produced by the shortage of graft.