Acute Liver Failure Anand Annamalai Incidence Etiology Lee
- Slides: 17
Acute Liver Failure Anand Annamalai
Incidence & Etiology Lee et al
Multi-organ Failure Nevens et al
Cerebral Edema
Potential Predictors of Poor Prognosis in Acute Liver Failure
STATUS 1 A - UNOS
LIVER TRANSPLANTATION AS THE GOLD STANDARD FOR ASSESSING ALTERNATE STRATEGIES TO MANAGE ACUTE LIVER FAILURE
Survival • Before the option of liver transplant and advanced intensive unit care, the overall survival in the US was 10 -20% • Now, with advancements in ICU management transplant-free survival is 40%
Survival • Overall survival with both transplantation and ICU management is >60%
Cadaveric Transplantation Survival Rates
Similar Survival Trend in Liver Transplantation after 1 year between ALF and cirrhosis
Predictors of poor prognosis No proven model exists to accurately predict who will benefit from transplantation Inaccurate selection may have serious effects: survival without OLT? mortality without OLT? Leads to unnecessary surgery, lifelong immunosuppression, utilization of a scarce resource (hepatic graft) vs death
Factors Affecting Outcome of Emergency Transplantation • Age < 50 – Age related reduction in physiological reserve associated with extreme stress in ALF • Severity of Illness – • Acetaminophen 2 x higher mortality after OLT compared to other etiologies Graft quality – Small size, ABO-incompatibility, steatosis
Cadaveric Transplantation US Acute Liver Failure Study Group • Listing guidelines vary from institution to institution • Too sick to list? • Regional differences in organ shortage? • Unclear how many listed patients would survive without OLT? • Those that died off the OLT list deemed not sick enough may benefit from OLT? Some report > 20 % of transplanted patients would have survived without OLT
“To Do” OR “To Not To Do”
Anhepatic State: Bridge to OLT Removal of “dead” liver decreases toxin load and inflammatory response transiently Improves until systemic toxins accumulate Survival of 48 -72 hours
The Tough Decision • Time is of the essence – Emergent transplantation for survival • Unpredictability of outcome – Utility of organs in limited supply – May have had better outcome in another patient – Need to consider all organs
- Anand annamalai
- Acute liver failure criteria
- Paracetamol overdose stages
- Acute liver failure criteria
- Epirates
- Prevalence rate formula
- Purdah poem
- Acute fatty liver of pregnancy
- Aflp in pregnancy
- Acute fatty liver of pregnancy
- Neonatal liver failure
- J'overt
- Treatments for acute renal failure
- Acute vs chronic heart failure
- Acute brain failure
- Ductile fracture vs brittle fracture
- Ventricular escape rhythm
- Failure to fire pacemaker