CONSERVATIVE TREATMENT OF ACUTE HEPATIC-FAILURE

Treatment of patients with acute liver failure has considerably improv ed in recent years. Effective-treatment ofthese devastating situations requires early assessment of prognosis and early referal of these pat ients to specialized centers. The conservative management of extrahepa tic complications in intensive care units appears to contribute to a b etter survival of patients whether or, not they are subsequently submi tted to a transplantation procedure. Specific hepatocyte-targeted trea tment by prostaglandin E(2) or similar drugs can be an option in the f uture. Dramatic progress has been made in the temporary substitution o f liver function bridging the time period between liver failure and re sumption of hepatocellular function due to liver regeneration. Present ly artificial liver assist devices as well as the extracorporeal perfu sion of human or pig livers are evaluated in clinical trials. Initial results indicate that these measures allow to bridge the time until an appropriate donor liver is available, Permanent liver transplantation has been shown to save the lifes of many patients suffering from acut e liver failure. Selection of patients requiring urgent liver transpla ntation has been facilitated by the use of prognostic scores specifica lly adapted to the etiology of underlying liver disease. A temporary a uxiliary liver transplantation can be a better treatment option preven ting the patient from a life-long dependence upon medical surveillance and drug-induced immunosuppression.