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Anand AC, Nandi B, Acharya SK, et al. Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure. J Clin Exp Hepatol. 2020;10(5):477-517doi: 10.1016/j.jceh.2020.04.011.
Anand, A. C., Nandi, B., Acharya, S. K., Arora, A., Babu, S., Batra, Y., Chawla, Y. K., Chowdhury, A., Chaoudhuri, A., Eapen, E. C., Devarbhavi, H., Dhiman, R. K., Datta Gupta, S., Duseja, A., Jothimani, D., Kapoor, D., Kar, P., Khuroo, M. S., Kumar, A., Madan, K., Mallick, B., Maiwall, R., Mohan, N., Nagral, A., Nath, P., Panigrahi, S. C., Pawar, A., Philips, C. A., Prahraj, D., Puri, P., Rastogi, A., Saraswat, V. A., Saigal, S., Shalimar, Shukla, A., Singh, S. P., Verghese, T., Wadhawan, M. (2020). Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure. Journal of clinical and experimental hepatology, 10(5), 477-517. https://doi.org/10.1016/j.jceh.2020.04.011
Anand, Anil C, et al. "Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure." Journal of clinical and experimental hepatology vol. 10,5 (2020): 477-517. doi: https://doi.org/10.1016/j.jceh.2020.04.011
Anand AC, Nandi B, Acharya SK, Arora A, Babu S, Batra Y, Chawla YK, Chowdhury A, Chaoudhuri A, Eapen EC, Devarbhavi H, Dhiman RK, Datta Gupta S, Duseja A, Jothimani D, Kapoor D, Kar P, Khuroo MS, Kumar A, Madan K, Mallick B, Maiwall R, Mohan N, Nagral A, Nath P, Panigrahi SC, Pawar A, Philips CA, Prahraj D, Puri P, Rastogi A, Saraswat VA, Saigal S, Shalimar, Shukla A, Singh SP, Verghese T, Wadhawan M. Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure. J Clin Exp Hepatol. 2020 Sep-Oct;10(5):477-517. doi: 10.1016/j.jceh.2020.04.011. Epub 2020 Apr 22. PMID: 33029057; PMCID: PMC7527855.
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J Clin Exp Hepatol. 2020 Sep-Oct;10(5):477-517. doi: 10.1016/j.jceh.2020.04.011. Epub 2020 Apr 22.

Indian National Association for the Study of Liver Consensus Statement on Acute Liver Failure (Part-2): Management of Acute Liver Failure.

Journal of clinical and experimental hepatology

Anil C Anand, Bhaskar Nandi, Subrat K Acharya, Anil Arora, Sethu Babu, Yogesh Batra, Yogesh K Chawla, Abhijit Chowdhury, Ashok Chaoudhuri, Eapen C Eapen, Harshad Devarbhavi, Radha K Dhiman, Siddhartha Datta Gupta, Ajay Duseja, Dinesh Jothimani, Dharmesh Kapoor, Premashish Kar, Mohamad S Khuroo, Ashish Kumar, Kaushal Madan, Bipadabhanjan Mallick, Rakhi Maiwall, Neelam Mohan, Aabha Nagral, Preetam Nath, Sarat C Panigrahi, Ankush Pawar, Cyriac A Philips, Dibyalochan Prahraj, Pankaj Puri, Amit Rastogi, Vivek A Saraswat, Sanjiv Saigal, Shalimar, Akash Shukla, Shivaram P Singh, Thomas Verghese, Manav Wadhawan,

Affiliations

  1. Department of Gastroenterology, Kaliga Institute of Medical Sciences, Bhubaneswar, 751024, India.
  2. Department of Gastroenterology, Sarvodaya Hospital and Research Centre, Faridababd, Haryana, India.
  3. Department of Gastroenterology and Hepatology, KIIT University, Patia, Bhubaneswar, Odisha, 751 024, India.
  4. Institute of Liver Gastroenterology & Pancreatico Biliary Sciences, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110 060, India.
  5. Department of Gastroenterology, Krishna Institute of Medical Sciences, Hyderabad, 500003, India.
  6. Department of Gastroenterology, Indraprastha Apollo Hospital, SaritaVihar, New Delhi, 110 076, India.
  7. Department of Gastroenterology, Kalinga Institute of Medical Sciences (KIMS), Kushabhadra Campus (KIIT Campus-5), Patia, Bhubaneswar, Odisha, 751 024, India.
  8. Department of Hepatology, School of Digestive and Liver Diseases, Institute of Post Graduate Medical Education & Research, Kolkata, 700020, India.
  9. Hepatology and Liver Transplant, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India.
  10. Department of Hepatology, Christian Medical College, Vellore, India.
  11. Department of Gastroenterology and Hepatology, St. John's Medical College Hospital, Bangalore, 560034, India.
  12. Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160 012, India.
  13. Department of Pathology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110 029, India.
  14. Institute of Liver Disease and Transplantation, Dr Rela Institute and Medical Centre, Chrompet, Chennai, 600044, India.
  15. Gleneagles Global Hospitals, Hyderabad, Telangana, India.
  16. Department of Gastroenterology and Hepatology, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh, 201 012, India.
  17. Department of Gastroenterology, Dr Khuroo' s Medical Clinic, Srinagar, Kashmir, India.
  18. Gastroenterology and Hepatology, Max Smart Super Specialty Hospital, Saket, New Delhi, India.
  19. Department of Gastroenterology, Kalinga Institute of Medical Sciences, Bhubaneswar, 751024, India.
  20. Hepatology Incharge Liver Intensive Care, Institute of Liver & Biliary Sciences, D-1 Vasant Kunj, New Delhi, India.
  21. Department of Pediatric Gastroenterology, Hepatology & Liver Transplantation, Medanta - the MedicityHospital, Sector - 38, Gurgaon, Haryana, India.
  22. Department of Gastroenterology, Apollo and Jaslok Hospital & Research Centre, 15, Dr Deshmukh Marg, Pedder Road, Mumbai, Maharashtra, 400 026, India.
  23. Liver & Digestive Diseases Institute, Fortis Escorts Hospital, Okhla Road, New Delhi, 110 025, India.
  24. The Liver Unit and Monarch Liver Lab, Cochin Gastroenterology Group, Ernakulam Medical Centre, Kochi 682028, Kerala, India.
  25. Department of Hepatology and Gastroenterology, Fortis Escorts Liver & Digestive Diseases Institute (FELDI), Fortis Escorts Hospital, Delhi, India.
  26. Department of Liver Transplantation, Medanta - the MedicityHospital, Sector - 38, Gurgaon, Haryana, India.
  27. Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow, Uttar Pradesh, 226 014, India.
  28. Department of Hepatology, Department of Liver Transplantation, India.
  29. Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi, 29, India.
  30. Department of Gastroenterology, LTM Medical College & Sion Hospital, India.
  31. Department of Gastroenterology, SCB Medical College, Dock Road, Manglabag, Cuttack, Odisha, 753 007, India.
  32. Department of Gastroenterology, Government Medical College, Kozikhode, India.
  33. Institute of Liver & Digestive Diseases and Head of Hepatology & Liver Transplant (Medicine), BLK Super Speciality Hospital, Delhi, India.

PMID: 33029057 PMCID: PMC7527855 DOI: 10.1016/j.jceh.2020.04.011

Abstract

Acute liver failure (ALF) is not an uncommon complication of a common disease such as acute hepatitis. Viral hepatitis followed by antituberculosis drug-induced hepatotoxicity are the commonest causes of ALF in India. Clinically, such patients present with appearance of jaundice, encephalopathy, and coagulopathy. Hepatic encephalopathy (HE) and cerebral edema are central and most important clinical event in the course of ALF, followed by superadded infections, and determine the outcome in these patients. The pathogenesis of encephalopathy and cerebral edema in ALF is unique and multifactorial. Ammonia plays a crucial role in the pathogenesis, and several therapies aim to correct this abnormality. The role of newer ammonia-lowering agents is still evolving. These patients are best managed at a tertiary care hospital with facility for liver transplantation (LT). Aggressive intensive medical management has been documented to salvage a substantial proportion of patients. In those with poor prognostic factors, LT is the only effective therapy that has been shown to improve survival. However, recognizing suitable patients with poor prognosis has remained a challenge. Close monitoring, early identification and treatment of complications, and couseling for transplant form the first-line approach to manage such patients. Recent research shows that use of dynamic prognostic models is better for selecting patients undergoing liver transplantation and timely transplant can save life of patients with ALF with poor prognostic factors.

© 2020 Indian National Association for Study of the Liver. Published by Elsevier B.V.

Keywords: ACLF, Acute on Chronic liver Failure; AKI, Acute kidney injury; ALF, Acute Liver Failure; ALFED score; ALT, alanine transaminase; AST, aspartate transaminase; CNS, central nervous system; CT, Computerized tomography; HELLP, Hemolysis, elevated liver enzymes, and low platelets; ICH, Intracrainial hypertension; ICP, Intracrainial Pressure; ICU, Intensive care unit; INR, International normalised ratio; LAD, Liver assist device; LDLT, Living donor liver transplantation; LT, Liver transplantation; MAP, Mean arterial pressure; MELD, model for end-stage liver disease; MLD, Metabolic liver disease; NAC, N-acetyl cysteine; PALF, Pediatric ALF; WD, Wilson's Disease; acute liver failure; artificial liver support; liver transplantation; plasmapheresis

Conflict of interest statement

Dr Subrat K Acharya Has nothing to declare. This consensus statement was written by the members of the Task Force on Acute Liver failure (INASL-ALF Task Force), convened by Indian National Association

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