Acute Liver Failure

Acute Liver Failure (ALF) is a syndrome characterised by deterioration in liver function in previously normal individuals over a period of 16 weeks and manifests as progressively worsening jaundice, liver function and encephalopathy (coma) . In the pre-transplant era, ALF had uniformly poor outcome with a significant number ending in death. However with better intensive care management and timely liver transplantation, many of these patients who are usually younger than those with cirrhosis, can be saved. Transplantation is considered only in patients who develop features of hepatic encephalopathy and severe deterioration in liver function or those who meet recognised criteria (King's College or Clichy). It is therefore prudent, at least in countries where transplantation is not widely accessible, that before the onset of coma and multiorgan failure ensue, patients who continue to have deteriorating liver function be shifted to facilities where transplantation can be offered . Early recognition and risk stratification followed by timely transplantation when indicated is the only way to save patients with ALF.