Liver transplantation in acute liver failure:Dilemmas and challenges

作     者：Ramesh Kumar Utpal Anand Rajeev Nayan Priyadarshi 

作者机构：Department of GastroenterologyAll India Institute of Medical SciencesPatna 801507BiharIndia Department of Surgical GastroenterologyAll India Institute of Medical SciencesPatna 801507BiharIndia Department of RadiodiagnosisAll India Institute of Medical SciencesPatna 801507BiharIndi 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2021年第11卷第6期

页      面：187-202页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Acute liver failure Fulminant hepatic failure Prognosis Kings college criteria Liver transplantation Acetaminophen 

摘      要：Acute liver failure(ALF)refers to a state of severe hepatic injury that leads to altered coagulation and sensorium in the absence of pre-existing liver *** has different causes,but the clinical characteristics are strikingly *** clinical practice,however,inconsistency in the definition of ALF worldwide and confusion regarding the existence of pre-existing liver disease raise diagnostic *** mortality rates used to be over 80%in the past;however,survival rates on medical treatment have significantly improved in recent years due to a greater understanding of pathophysiology and advances in critical care *** survival rates in acetaminophen-associated ALF have become close to the post-transplant survival *** that liver transplantation(LT)is an expensive treatment that involves a major surgical operation in critically ill patients and lifelong immunosuppression,it is very important to select accurate patients who may benefit from ***,emergency LT remains a lifesaving procedure for many ALF ***,there is a lack of consistency in current prognostic models that hampers the selection of transplant candidates in a timely and precise *** other problems associated with LT in ALF are the shortage of graft,development of contraindications on the waiting list,vaguely defined delisting criteria,time constraints for pre-transplant evaluation,ethical concerns,and comparatively poor post-transplant outcomes in ***,there is a desperate need to establish accurate prognostic models and explore the roles of evolving adjunctive and alternative therapies,such as liver support systems,plasma exchange,stem cells,auxiliary LT,and so on,to enhance transplant-free survival and to fill the void created by the graft shortage.