What is the mortality rate for acute liver failure (ALF)?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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Before the introduction of orthotopic liver transplantation (OLT) for fulminant hepatic failure, mortality was generally greater than 80%. Approximately 6% of OLTs performed in the United States are for fulminant hepatic failure. However, with improved intensive care, the prognosis is much better now than in the past, with some series reporting a survival rate of approximately 60%.

The etiologic factor and the development of complications are the main determinants of outcome in acute liver failure. Patients with acute liver failure caused by acetaminophen have a better prognosis than those with an indeterminate form of the disorder. Patients with stage 3 or 4 encephalopathy have a poor prognosis. The risk of mortality increases with the development of any complications, which include cerebral edema, renal failure, adult respiratory distress syndrome (ARDS), coagulopathy, and infection.

Preoperative prognostic factors for liver transplantation survival in patients with acute liver failure appear to include the recipient's pretransplantation lowest pH and body mass index. [34]  According to Hoyer et al, the recipient's lowest preoperative pH is also independently associated with inpatient mortality, in which the calculated cutoff is a pH of 7.26. [34]

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