Acute liver failure

Severe hepatitis A infection is an infrequent but well-recognized cause of acute liver failure that can now be effectively prevented with vaccination against hepatitis A virus. Bromfenac and troglitazone hepatotoxicity as wel l as various herbal remedies are some of the newly identified causes of acu te liver failure. The recently identified transfusion-transmitted virus has been implicated in some cases of idiopathic acute liver failure whereas he patitis G virus does not appear to be a causative agent. Recognizing, monit oring, and treating patients with life-threatening cerebral edema remain cr itically important but difficult aspects of the clinical care of acute live r failure. Hypothermia and N-acetylcysteine are promising experimental appr oaches to cerebral edema but emergency liver transplantation is the only pr oven means of improving patient survival. Although recent changes in organ allocation may reduce waiting time to transplantation, more reliable and va lidated markers of liver regeneration and prognosis are needed to triage pa tients, The potential application and limitations of novel technologies inc luding bioartificial liver devices and auxiliary liver transplantation cont inue to evolve from pioneering work in animal models and human subjects. (C ) 1999 Lippincott Williams & Wilkins, Inc.