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Emerging strategies for the treatment of patients with acute hepatic failure

Kandiah, Prem A.; Olson, Jody C.; Subramanian, Ram M.

Current Opinion in Critical Care: April 2016 - Volume 22 - Issue 2 - p 142–151
doi: 10.1097/MCC.0000000000000291
GASTROINTESTINAL SYSTEM: Edited by Craig Coopersmith

Purpose of review: The objective of this article is to review the latest developments related to the treatment of patients with acute liver failure (ALF).

Recent findings: As the treatment of ALF has evolved, there is an increasing recognition regarding the risk of intracranial hypertension related to advanced hepatic encephalopathy. Therefore, there is an enhanced emphasis on neuromonitoring and therapies targeting intracranial hypertension. Also, new evidence implicates systemic proinflammatory cytokines as an etiology for the development of multiorgan system dysfunction in ALF; the recent finding of a survival benefit in ALF with high-volume plasmapheresis further supports this theory.

Summary: Advances in the critical care management of ALF have translated to a substantial decrease in mortality related to this disease process. The extrapolation of therapies from general neurocritical care to the treatment of ALF-induced intracranial hypertension has resulted in improved neurologic outcomes. In addition, recognition of the systemic inflammatory response and multiorgan dysfunction in ALF has guided current treatment recommendations, and will provide avenues for future research endeavors. With respect to extracorporeal liver support systems, further randomized studies are required to assess their efficacy in ALF, with attention to nonsurvival end points such as bridging to liver transplantation.

aNeurology and Neurocritical Care, Emory University School of Medicine, Atlanta, Georgia

bHepatology and Critical Care Medicine, University of Kansas Medical Center, Kansas City, Kansas

cHepatology and Critical Care Medicine, Emory University School of Medicine, Atlanta, Georgia, USA

Correspondence to Ram M. Subramanian, MD, 1365 Clifton Road, NE, B 6100, Atlanta, GA 30322, USA. Tel: +1 404 712 6321; fax: +1 404 778 2350; e-mail: rmsubra@emory.edu

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