Acute Liver Failure

Acute liver failure (ALF) — also called fulminant hepatic failure — is a rare but rapidly progressive and life-threatening condition in which the liver loses the ability to function within days to weeks in a person with no pre-existing liver disease. It is defined by the presence of coagulopathy (impaired blood clotting, INR ≥1.5) and hepatic encephalopathy occurring within 26 weeks of the onset of illness. Common causes include viral hepatitis (particularly hepatitis A, E, and herpes viruses), drug-induced liver injury (paracetamol/acetaminophen overdose being the leading cause globally, as well as anti-tuberculosis drugs and herbal preparations in India), Wilson's disease, Budd-Chiari syndrome, and autoimmune hepatitis.

The clinical course of ALF is unpredictable and can deteriorate with alarming speed. Patients typically present with jaundice, fatigue, right upper quadrant discomfort, and nausea, rapidly progressing to confusion, bleeding tendency, hypoglycaemia, kidney failure, and multiorgan dysfunction. The development of cerebral oedema and raised intracranial pressure is a leading cause of death. ALF demands urgent referral to a specialised liver unit with intensive care monitoring and the capability to perform emergency liver transplantation.

Management of acute liver failure involves intensive supportive care — N-acetylcysteine for paracetamol toxicity, lactulose and rifaximin for encephalopathy, fresh frozen plasma and vitamin K for coagulopathy, and dialysis for hepatorenal syndrome. Prognostic scoring systems such as the King's College Criteria and MELD score are used to identify patients unlikely to survive without transplantation. In suitable candidates, emergency liver transplantation — from either a living donor or a deceased donor — can be life-saving, with excellent long-term outcomes. Our team at Ahmedabad Liver Surgeons is experienced in the urgent evaluation and surgical management of acute liver failure.