Review sul management dell’insufficienza epatica acuta

Review article: current management of acute liver failure.Craig DG, Lee A, Hayes PC, Simpson KJ. Aliment Pharmacol Ther. 2009 Oct 21. [Epub ahead of print] SUMMARY Background Acute liver failure (ALF) is a devastating clinical syndrome with a persistently high mortality rate despite critical care advances. Orthotopic liver transplantation (OLT) is a life-saving treatment in selected cases, but effective use of this limited resource requires accurate prognostication due to surgical risks and the requirement for subsequent life-long immunosuppression. Aims To review the aetiology of ALF, discuss the evidence behind critical care management strategies and examine potential treatment alternatives to OLT. Methods Literature review using Ovid, Pubmed and recent conference abstracts. Results Paracetamol remains the most common aetiology of ALF in developed countries, whereas acute viral aetiologies predominate elsewhere. Cerebral oedema is a major cause of death, and its prevention and prompt recognition are vital components of critical care support, which strives to provide multi-organ support and ‘buy time’ to permit either organ regeneration or psychological and physical assessment prior to acquisition of a donor organ. Artificial liver support systems do not improve mortality in ALF, whilst most other interventions have limited evidence bases to support their use. Conclusions ALF remains a truly challenging condition to manage, and requires early recognition and transfer of patients to specialist centres providing intensive, multidisciplinary input, and, in some cases, OLT. 

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