Clinical management of acute hepatic failure

Acute hepatic failure is a rare clinical syndrome associated with high mort ality. Hepatic failure leads to a well-recognised pattern of clinical signs and symptoms, sometimes with rapid deterioration and progression to multi- organ failure. Early recognition of this syndrome is essential for appropri ate treatment; once identified, patients benefit from early interventional support and treatment in the intensive care unit. Aggressive management may allow stabilisation of patients before their transfer to specialist liver units. At present, orthotopic liver transplantation is the only treatment m odality that provides significant improvement in outcome. This review exami nes the aetiology and clinical presentation of acute hepatic failure, provi ding guidelines regarding patient management. We present a critical apprais al of specific clinical areas, including the management of cardiovascular, cerebral, renal, coagulopathic and infective complications. Liver transplan tation is discussed as well as emerging therapies including non-biological and hybrid liver support systems that may provide a "bridge to transplantat ion".