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Abstract
Acute liver failure is a rare disorder with high mortality and resource cost. In the
developing world, viral causes predominate, with hepatitis E infection recognised
as a common cause in many countries. In the USA and much of western Europe, the incidence
of virally induced disease has declined substantially in the past few years, with
most cases now arising from drug-induced liver injury, often from paracetamol. However,
a large proportion of cases are of unknown origin. Acute liver failure can be associated
with rapidly progressive multiorgan failure and devastating complications; however,
outcomes have been improved by use of emergency liver transplantation. An evidence
base for practice is emerging for supportive care, and a better understanding of the
pathophysiology of the disorder, especially in relation to hepatic encephalopathy,
will probably soon lead to further improvements in survival rates.
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