Support for the Acutely Failing Liver: A Comprehensive Review of Historic and Contemporary Strategies

M l T p c s e m t e a a s s b c o s c p nd-stage liver disease is the tenth most frequent cause f death in the US, causing approximately 25,000 deaths nnually. Although only about 2,000 cases of acute liver ailure occur each year in the US, the mortality rate emains as high as 28%. The application of orthotopic iver transplantation to acute and fulminant hepatic failre has increased the survival rate dramatically, but this reatment option is costly, and the limited supply of uitable livers precludes this treatment option from beng available to all patients who would benefit from it. pproximately 40% of patients with acute or fulminant epatic failure survive the acute episode with medical herapy alone, and regeneration in the native liver akes orthotopic liver transplantation, an irreversible reatment option, unnecessary. Unfortunately, there is o effective means to distinguish patients who will surive without transplantation from those who will not. The term acute-on-chronic typically refers to the acute nset or acute worsening of hepatic encephalopathy in paients with chronic liver disease. Some of the events or gents that may precipitate acute-on-chronic liver failure nclude oral protein intake, gastrointestinal hemorrhage, zotemia, hypoxia, or sedative or hypnotic drugs. Alhough some degree of neuropsychiatric disturbance is ommon in patients with chronic liver disease, overt enephalopathy portends a grim prognosis: survival is only 2% at 1 year and 23% at 3 years. Few effective treatment ptions, as for acute liver failure, exist for acute-on-chronic iver disease except liver transplantation. Support options exist for patients with failure of other rgan systems: hemodialysis and peritoneal dialysis for enal failure, extracorporeal membrane oxygenation for