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Acute Liver Failure 급성간부전 KLTS Coordinator Session (K*) Acute Liver Failure Dong Jin Joo Department of Surgery, Yonsei University College of Medicine, Seoul, Korea 급성간부전 주 동 진 연세대학교 의과대학 외과학교실 Acute liver failure (ALF) is a rare disease but it could be life-threatening and devastating condition with up to 30- 50% mortality rate, which occurs mostly in patients who do not have preexisting liver disease. The incidence of ALF is around 10 cases per million persons per year in the developed countries. Some cases may be salvaged by vigorous medical treatment together with the liver’s capacity for regeneration, but orthotopic liver transplantation remains the definitive therapy for medically refractory ALF. Conventionally, fulminant hepatic failure is defined as a severe liver injury, potentially reversible in nature and with onset of hepatic encephalopathy within 8 weeks of the first symptoms in the absence of preexisting liver disease. But, the time gap between jaundice and hepatic encephalopathy differs according to the causes of liver failure. Globally, hepatitis A and E infections are related to acute liver failure, with rates of mortality of more than 50% reported from the developing countries. ALF can be caused by hepatitis B infection. Particularly in Korea, acute on chronic liver failure caused by hepatitis B is not uncommon and sometimes ALF can occur in patients with reactiva- tion of previously stable subclinical HBV infection without established chronic liver disease. Another important cause of ALF is drug-induced liver injury. Drug-induced liver injury is responsible for approximately 50% of cases of acute liver failure in the United States. Acetaminophen is the most common hepatotoxic drug that could induce ALF in western countries. Unlike western countries, herbal medicine can be noticed the cause of ALF in many Asian countries. Other causes of ALF are hypoxia-induced liver injury, neoplastic infiltration, acute Budd–Chiari syndrome, heatstroke, mushroom ingestion, and metabolic diseases such as Wilson’s disease. Rarely, pregnancy-re- lated ALF can occur before deliver of baby, which may require early delivery of the fetus. However, in many cases, the cause of acute liver failure remains unknown, despite intensive investigation. These cases often follow a subacute presentation, and rates of survival are poor without transplantation. Supportive therapies such as albumin dialysis units or bio-artificial livers are designed to provide a favorable milieu for regeneration by detoxifying waste molecules and providing synthetic function. These devices should bridge the patients until donor organs became available, or ideally, allow the patients to avoid liver transplantations altogether. But so far, there was no report to show survival benefit in these ALF patients. Thus, liver transplantation should be considered from the early period of ALF diagnosis. 108 June 20-22, 2019 ｜ BEXCO, Busan, South Korea KLTS Coordinator Session (*K) References 1. Bernal W, Wendon J. Acute liver failure. N Engl J Med 2013; 369: 2525-34. June 20 (Thu) 2. Chen HS, Joo DJ, Shaheen M, Li Y, Wang Y, Yang J, Nicolas CT, Predmore K, Amiot B, Michalak G, et al. Randomized Trial of Spheroid Reservoir Bioartificial Liver in Porcine Model of Posthepatectomy Liver Failure. Hepatology 2019; 69: 329-42. 3. Trey C, Davidson CS. The management of fulminant hepatic failure. Prog Liver Dis 1970; 3: 282-98. 4. Ostapowicz G, Fontana RJ, Schiodt FV, Larson A, Davern TJ, Han SH, McCashland TM, Shakil AO, Hay JE, Hynan L, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137: 947-54. 5. Mendizabal M, Tagliafichi V, Rubinstein F, Rojas P, Marciano S, Yantorno S, Cejas N, Barrabino M, Anders M, Cairo F, et al. Liver transplantation in adults with acute liver failure: Outcomes from the Argentinean Transplant Registry. Ann Hepa- tol 2019. 6. Leao GS, Lunardi FL, Picon RV, Tovo CV, de Mattos AA, de Mattos AZ. Acute-on-chronic liver failure: A comparison of (Fri) 21 June three different diagnostic criteria. Ann Hepatol 2019. 7. de Mattos AZ, de Mattos AA. Acute-on-chronic liver failure - conceptual divergences. Hepatology 2019. June 22 (Sat) www.theliverweek.org 109.
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