Acute Liver Failure

Liver Failure

What is Liver Failure ?
Liver failure occurs when the liver is unable to perform its functions. This usually happens when there is overwhelming damage to more than 80 percent of the liver cells due to an infection, toxin or drug. Liver injury of a lesser magnitude causes hepatitis. Although hepatitis is fairly common in the population, liver failure occurs in only 1-2 percent of patients with hepatitis.

What are the signs of Liver failure ?
The presence of only jaundice does not mean liver failure. When patients with jaundice develop mental confusion, swelling of the abdomen of legs due to accumulation of excess fluid, and abnormality of blood clotting, it signifies liver failure.

What are the types of Liver Failure ?
Liver failure is known as “acute” when a patient develops mental confusion within 4 weeks after the onset of jaundice. Liver failure is known as “subacute” when a patient develops mental confusion or swelling of the abdomen beyond 4 weeks but within 6 months after onset of jaundice.

What causes Liver Failure ?
Viral infections, excess alcohol intake, certain medications, and toxins can cause liver failure. Herbal drugs have unknown toxicities and can cause liver failure. Certain autoimmune and metabolic diseases can also cause liver failure. There are many patients in whom the exact cause of liver failure cannot be found. Usually these cases are attributed to unknown viruses or medications.

How is Liver Failure diagnosed ?
Liver failure is diagnosed on the basis of clinical symptoms such as presence of mental confusion and excess fluid accumulation in a patient with jaundice. Clotting of blood becomes abnormal and this can be detected by a test known as prothrombin time. Levels of ammonia and lactic acid in the blood also get elevated in patients with liver failure.

What is the treatment of Liver Failure ?
The treatment of liver failure in mainly supportive. Although it is important to find the cause of liver failure, but specific treatment of viruses and drugs is usually not available. Patients are managed in an intensive care unit. Complications such as infections, kidney failure, low blood sugar have to be prevented. Adequate nutrition has to be provided. Regular blood tests are done to monitor the progress of the patient.

Can a patient with Liver Failure recover with medical management ?
About 20 percent patients can recover. Liver is one of the few organs in the human body that has immense regenerative potential. Even after massive liver injury leading to liver failure, the liver cells over a period of time can regenerate to form a functioning liver. Unfortunately most patients with liver failure deteriorate rapidly and develop complications leading to death and there is not enough time for liver cells to regenerate.

When is a transplant required for a patient with Liver Failure ?
Any patient with jaundice, who develops signs of liver failure, should be transferred to a hospital with facilities for liver transplant. Close monitoring of patients is required to look for clinical deterioration so that a timely transplant can be performed. Unnecessary delay can prove fatal since substantial time is required for counseling of family, evaluation of the patient, search for an appropriate living donor and evaluation of the donor. It is important to prepare for a transplant at the earliest. In case a patient does show improvement, transplant may not be required.

What are the types of Liver Transplant done in Liver Failure ?

Liver transplants are of two types. The most common form of transplant done in the setting of liver failure is a living donor transplant. In this a healthy person donates part of his liver to a patient with liver failure. The other type is a cadaveric transplant in which families of unfortunate patients with serious brain injury, after declaration of brain death, opt to donate their organs. Organs such as liver, kidney, heart, lungs, intestine and eyes can be donated from brain dead patients.

What are the results of Liver Transplant done for liver failure ?
With advancements in surgical skills, medical technology and availability of excellent drugs that prevent rejection, over 90 percent patients do well after transplant for liver failure. Lifelong medications, blood tests and medical care is required. Most liver transplant patients, adults or children, can lead healthy and normal productive lives.