Published online Jan 28, 2016. doi: 10.3748/wjg.v22.i4.1523
Peer-review started: May 5, 2015
First decision: September 29, 2015
Revised: October 14, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: January 28, 2016
Acute liver failure is a critical medical condition defined as rapid development of hepatic dysfunction associated with encephalopathy. The prognosis in these patients is highly variable and depends on the etiology, interval between jaundice and encephalopathy, age, and the degree of coagulopathy. Determining the prognosis for this population is vital. Unfortunately, prognostic models with both high sensitivity and specificity for prediction of death have not been developed. Liver transplantation has dramatically improved survival in patients with acute liver failure. Still, 25% to 45% of patients will survive with medical treatment. The identification of patients who will eventually require liver transplantation should be carefully addressed through the combination of current prognostic models and continuous medical assessment. The concerns of inaccurate selection for transplantation are significant, exposing the recipient to a complex surgery and lifelong immunosuppression. In this challenging scenario, where organ shortage remains one of the main problems, alternatives to conventional orthotopic liver transplantation, such as living-donor liver transplantation, auxiliary liver transplant, and ABO-incompatible grafts, should be explored. Although overall outcomes after liver transplantation for acute liver failure are improving, they are not yet comparable to elective transplantation.
Core tip: Acute liver failure is the most dramatic clinical situation in which liver transplantation is performed. In this manuscript, we describe the timing and benefits of this procedure by analyzing the different prognostic scores and surgical techniques.