VIRAL CAUSES AND MANAGEMENT OF ACUTE LIVER-FAILURE

Infection with an identified hepatotrophic virus accounts for 13-50% o f acute liver failure (ALF) in Europe, and an additional 16-17% of cas es have non-A non-B or indeterminate hepatitis in whom a viral aetiolo gy is presumed. Hepatitis C is rarely responsible for acute fiver fail ure in Europe and North America but accounts for a higher proportion o f cases in Japan, and hepatitis E may lead to ALF, particularly in pre gnant women. The survival in cases of acute liver failure associated w ith hepatitis A is 70%, whereas less than 30% of those with non-A non- B hepatitis survive without a transplant. Management depends on intens ive care support and careful selection of patients likely to benefit f rom transplantation. Recurrence of hepatitis A and non-A non-B hepatit is has been reported following transplantation for ALF, and hepatitis B recurs less frequently in these circumstances than after transplanta tion for chronic infection. (C) Journal of Hepatology.