Acute liver failure

Worldwide, viral hepatitis is the leading cause of acute liver failure, whe reas acetaminophen hepatotoxicity is the most commonly identified cause in Western countries. Restricting the quantity of acetaminophen tablets dispen sed has been shown to reduce morbidity and mortality in countries with a hi gh incidence of acetaminophen overdose. Troglitazone and bromfenac are two recently approved medications that were withdrawn from the market due to an unacceptably high incidence of severe hepatotoxicity, In addition, trovafl oxacin, nefazodone, and ritonavir were reported to be associated with sever e hepatitis and acute liver failure. Moderate hypothermia is a simple and p otentially effective means of reducing intracranial pressure in patients wi th acute liver failure and cerebral edema. However, controlled clinical tri als are needed to determine proper patient selection and optimize treatment . Extracorporeal bioartificial liver support devices remain an exciting but as yet unproven means of supporting acute liver failure patients with adva nced encephalopathy. Living donor liver transplantation has recently been r eported for adults and children with acute liver failure. However, ethical concerns regarding donor safety and the ability to obtain informed consent without coercion have been raised. Lastly, advances in the identification a nd isolation of pluripotent liver stem cells in human bone marrow provides hope for a simple and effective means of enhancing native liver regeneratio n. Curr Opin Gastroenterol 2001, 17:291-198 (C) 2001 Lippincott Williams & Wilkins, Inc.