Acute liver failure

Diagnosis

Tests and procedures used to diagnose acute liver failure include:

• Blood tests. Blood tests can show how well the liver works. A prothrombin time test measures how long it takes blood to clot. With acute liver failure, blood doesn't clot as quickly as it should.
• Imaging tests. A healthcare professional may recommend an ultrasound exam to look at the liver. Such testing may show liver damage and help find the cause of the liver problems. A health professional also may recommend abdominal computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to look at the liver and blood vessels. These tests can look for certain causes of acute liver failure, such as Budd-Chiari syndrome or tumors. They may be used if a problem is suspected and ultrasound testing does not find the problem.

• Examination of liver tissue. A healthcare professional may recommend removing a small piece of liver tissue, called a liver biopsy. Doing so may help discover why the liver is failing.

  Since people with acute liver failure are at risk of bleeding during biopsy, a transjugular liver biopsy may be performed. This procedure involves making a tiny incision on the right side of the neck. A thin tube called a catheter is then inserted into a neck vein, through the heart and into a vein exiting the liver. A needle is then threaded through the catheter to retrieve a sample of liver tissue.

Treatment

People with acute liver failure often receive treatment in the intensive care unit of a hospital in a facility that can perform a liver transplant, if necessary. A healthcare professional may try to treat the liver damage itself, but in many cases, treatment involves controlling complications and giving the liver time to heal.

Acute liver failure treatments may include:

• Medicines to reverse poisoning. Acute liver failure caused by acetaminophen overdose is treated with a medicine called acetylcysteine. This medicine also may help treat other causes of acute liver failure. Mushroom and other poisonings also may be treated with medicines that can reverse the effects of the toxin and may reduce liver damage.
• Liver transplant. When acute liver failure can't be reversed, the only treatment may be a liver transplant. During a liver transplant, a surgeon removes the damaged liver and replaces it with a healthy liver from a donor.

A healthcare professional also will typically work to control symptoms and try to prevent complications caused by acute liver failure. Care may include:

• Relieving pressure caused by excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on the brain. Medicines can help reduce the fluid buildup in your brain.
• Screening for infections. Your medical team may take samples of your blood and urine every now and then to be tested for infection. If your team suspects that you have an infection, you'll receive medicines to treat the infection.
• Preventing severe bleeding. Your care team can give you medicines to reduce the risk of bleeding. If you lose a lot of blood, tests may be done to find the source of the blood loss. Blood transfusions may be needed.
• Providing nutritional support. If you're not able to eat, you may need supplements to treat nutritional deficiencies.

Future treatments

Scientists continue to research new treatments for acute liver failure, especially those that could reduce or delay the need for a liver transplant. While several possible future treatments are being explored, it's important to remember that the treatments are experimental and may not yet be available.

These treatments are among those being studied:

• Artificial hepatic assist devices. A machine would do the job of the liver, much like dialysis helps when the kidneys stop working. There are many different types of devices being studied. Research suggests that some, but not all, devices may improve survival. A well-controlled multicenter trial showed that one system, called an extracorporeal liver support system, helped some people with acute liver failure survive without a transplant. The treatment also is called high-volume plasma exchange. However, more study is needed for this therapy.
• Hepatocyte transplantation. Transplanting only the cells of the liver — not the entire organ — may temporarily delay the need for a liver transplant. In some cases, a short-term delay could lead to a complete recovery. A shortage of good-quality donor livers has limited the use of this treatment.
• Auxiliary liver transplantation. This procedure involves removing a small piece of your liver and replacing it with a similarly sized graft. This allows your own liver to regenerate without the need for immunosuppressant drugs. At this time, auxiliary liver transplantation is a difficult procedure that needs more research.
• Xenotransplantation. This type of transplant replaces the human liver with a liver from an animal or other nonhuman source. Doctors performed experimental liver transplants using pig livers several decades ago, but results were disappointing. However, advancements in immune and transplant medicine have prompted researchers to consider this treatment again. It may help provide support for those waiting for a human liver transplant.

Preparing for your appointment

If a healthcare professional suspects you have acute liver failure, you'll likely be admitted to a hospital for treatment. Most people with acute liver failure are treated in an intensive care unit.

What you can do

If you have been diagnosed with acute liver failure, here are some questions to ask your care team:

• What caused my acute liver failure?
• Can it be reversed?
• If it can be reversed, can my liver completely heal?
• What are the treatments?
• Will I need a liver transplant?
• Does this hospital have a liver transplant unit?
• Should I transfer to a hospital that performs liver transplants?

What to expect from your doctor

Your care team will ask you or your family questions to try to find the cause of your acute liver failure, including:

• When did symptoms begin?
• What prescription medicines do you take?
• What over-the-counter medicines do you take?
• What herbal supplements do you take?
• Do you use illegal drugs?
• Have you had liver problems in the past?
• Have you been diagnosed with hepatitis or jaundice?
• Do you have a history of depression or suicidal thoughts?
• How much alcohol do you drink?
• Have you recently started taking new medicines?
• Do you take acetaminophen (Tylenol, others)? How much?
• Do liver problems run in your family?

Living with acute liver failure?

Connect with others like you for support and answers to your questions in the Transplants support group on Mayo Clinic Connect, a patient community.

Transplants Discussions

See more discussions