Institute of Liver Studies, King's College London School of Medicine at King's College Hospital, King's College Hospital, Denmark Hill, London, UK.
Metab Brain Dis. 2013 Mar;28(1):7-10. doi: 10.1007/s11011-012-9363-1. Epub 2012 Dec 4.
Over the past 35 years, the outlook for a patient presenting with acute liver failure (ALF) has changed beyond all recognition. A patient presenting in 1984 had an 80 % likelihood of succumbing to intracranial hypertension. Today due to dramatic improvements in intensive care in dedicated liver transplant units, this has been reduced to just 20 %. Prompt fluid resuscitation, empirical treatment for sepsis and standardised management protocols that include early intubation and high flow hemofiltration for ammonia removal, limit the numbers of patients who die from the sequelae of cerebral edema and ALF. With the evolution and development of bedside prognostic markers that will include personalised genomic, metabonomic and immune profiling, rationalisation of grafts to those who are not predicted to survive is likely to further minimise the number of grafts utilised. Furthermore, in those patients with a dismal prognosis, the use of plasmapheresis, immunomodulatory therapies, biological liver support systems and hepatocyte transplantation offer a potential bridge until the injured liver can begin to regenerate avoiding transplantation and life-long immunosuppressant therapy.
在过去的 35 年中，急性肝衰竭（ALF）患者的预后发生了翻天覆地的变化。1984 年出现的患者有 80%的可能性死于颅内压升高。如今，由于专门的肝移植中心重症监护的显著改善，这一比例已降至 20%。及时的液体复苏、脓毒症的经验性治疗以及包括早期插管和高流量血液滤过以去除氨的标准化管理方案，限制了因脑水肿和 ALF 后遗症而死亡的患者数量。随着床边预后标志物的发展和进步，包括个性化基因组、代谢组学和免疫分析，将移植物分配给那些预计无法存活的患者，这可能会进一步减少移植物的使用数量。此外，对于预后不佳的患者，使用血浆置换、免疫调节治疗、生物肝支持系统和肝细胞移植可以提供潜在的桥梁，直到受损的肝脏开始再生，从而避免移植和终身免疫抑制剂治疗。
