Conservative treatment of acute hepatic failure.

Treatment of patients with acute liver failure has considerably improved in recent years. Effective treatment of these devastating situations requires early assessment of prognosis and early referral of these patients to specialized centers. The conservative management of extrahepatic complications in intensive care units appears to contribute to a better survival of patients whether or not they are subsequently submitted to a transplantation procedure. Specific hepatocyte-targeted treatment by prostaglandin E2 or similar drugs can be an option in the future. Dramatic progress has been made in the temporary substitution of liver function bridging the time period between liver failure and resumption of hepatocellular function due to liver regeneration. Presently, artificial liver assist devices as well as the extracorporeal perfusion of human or pig livers are evaluated in clinical trials. Initial results indicate that these measures allow to bridge the time until an appropriate donor liver is available. Permanent liver transplantation has been shown to save the lives of many patients suffering from acute liver failure. Selection of patients requiring urgent liver transplantation has been facilitated by the use of prognostic scores specifically adapted to the etiology of underlying liver disease. A temporary auxiliary liver transplantation can be a better treatment option preventing the patient from a life-long dependence upon medical surveillance and drug-induced immunosuppression.