Acute hepatic failure: A Western perspective

Acute hepatic failure (AHF) is an uncommon, devastating syndrome, which res ults in death or the need for liver transplantation in more than 50% of cas es. While AHF has numerous causes, most cases are due to viral hepatitis an d drug toxicity or idiosyncratic reactions. A significant group with indete rminate causation remains, despite careful investigation. In many of these cases a viral aetiology is suspected, although yet not proven. Major differ ences exist in the aetiology of AHF between the West and Eastern countries. A wider range of aetiologies exists in the West. Common causes include ace taminophen toxicity and idiosyncratic drug reactions, while viral hepatitis is less frequent. Hepatitis E infection is rarely seen in Western countrie s in contrast to its high prevalence in the East. The mainstay of AHF manag ement is supportive care in an intensive care unit. Liver transplantation i s now the standard of care in many Western liver units for individuals who have a less than 20% probability of survival. Lack of availability of donor livers at short notice remains a significant problem. Methods of liver sup port used while waiting for a donor liver or for the native liver to regene rate include bioartificial livers, extracorporeal liver-assist devices, ext racorporeal whole organ perfusion (human and transgenic pig) and hepatocyte transplantation. The effectiveness of these methods remains unproven and a waits controlled clinical trials. Both transplantation and liver-support me thods require specialized units and expensive and complicated equipment. Fu rther research is necessary to identify modalities of therapy that would be effective as well as widely accessible. (C) 2000 Blackwell Science Asia Pt y Ltd.