Management-acute liver failure

(J Clin Exp Hepatol 2015;5:S104; Gastro 2017;152:644)

• ICU care at liver transplant center for hemodynamic & ventilatory support; CVVH for AKI

• Early listing for liver transplantation in selected Pts (see below)

• Cerebral edema-Management-acute liver failure:

• Encephalopathy: intubate for grade 3 or 4; lactulose is of little benefit & may be detrimental

• Coagulopathy: vit K, FFP/plts/cryo only if active bleeding (↑ risk of volume overload)

• Infection: low threshold for abx (broad spectrum, eg, vancomycin & 3rd-gen ceph.) if suspect infection; anti-fungal coverage in high-risk Pts (TPN, CVVH)

• Rx of specific causes: NAC if acetaminophen; antiviral for HBV; plasma exchange can be temporizing measure for Wilson disease; IV acyclovir for HSV; PCN-G for A. phalloides; delivery of child for pregnancy-related; TIPS, anticoag for Budd-Chiari. Lack of data for use of steroids in autoimmune, but often given (Hepatology 2014;59:612).

• NAC may benefit Pts w/ non-APAP ALF but data inconclusive (Clin Drug Investig 2017;37:473)

King’s College Criteria for Liver Transplantation consideration: