Hadem Johannes, Strassburg Christian P, Manns Michael P
Department of Gastroenterology, Hepatology, and Endocrinology, Medical School Hannover Hannover, Germany.
Front Physiol. 2012 Aug 28;3:340. doi: 10.3389/fphys.2012.00340. eCollection 2012.
Acute liver failure (ALF) is characterized by a sudden and severe deterioration of liver function, typically mirrored by a marked increase of the international normalized ratio (INR) and hepatic encephalopathy (HE). Due to various possible causes hepatocytes get damaged via either apoptotic or necrotic pathways. Anticipating the natural prognosis of a patient with ALF is one of the most challenging tasks in hepatology critical care. Important factors that influence the chance of spontaneous recovery are the underlying etiology of acute liver failure, the acuity of disease, and the severity of HE. Once an estimation of the prognosis in the individual patient has been made, this quickly has to be integrated in the discussion whether high-urgency liver transplantation is necessary and justifiable. This decision has to cover several medical, social, and organizational issues. Well organized liver transplantation programs around the world have achieved an impressive improvement of the 1 year survival rate in ALF from around 40% without transplantation up to nearly 80% with transplantation. The recent debate on whether severe acute alcoholic hepatitis could represent a new candidate eligible for high-urgency liver transplantation shows that the topic is still open for discussion.
急性肝衰竭（ALF）的特征是肝功能突然严重恶化，通常表现为国际标准化比值（INR）显著升高和肝性脑病（HE）。由于各种可能的原因，肝细胞通过凋亡或坏死途径受损。预测ALF患者的自然预后是肝脏病重症监护中最具挑战性的任务之一。影响自发恢复机会的重要因素包括急性肝衰竭的潜在病因、疾病的急性程度以及肝性脑病的严重程度。一旦对个体患者的预后做出评估，就必须迅速将其纳入关于是否有必要且合理进行高紧急度肝移植的讨论中。这一决定必须涵盖多个医学、社会和组织问题。世界各地组织完善的肝移植项目已使ALF患者的1年生存率取得了令人瞩目的提高，从无移植情况下的约40%提高到有移植情况下的近80%。最近关于严重急性酒精性肝炎是否可能成为高紧急度肝移植新候选对象的争论表明，这个话题仍有待讨论。
