Acute liver failure

Diagnosis

Tests and procedures used to diagnose acute liver failure include:

• Blood tests. Blood tests are done to determine how well your liver works. A prothrombin time test measures how long it takes your blood to clot. With acute liver failure, blood doesn't clot as quickly as it should.
• Imaging tests. Your health care provider may recommend an ultrasound exam to look at your liver. Such testing may show liver damage and help determine the cause of your liver problems. Your provider may also recommend abdominal computerized tomography (CT) scanning or magnetic resonance imaging (MRI) to look at your 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 your provider suspects a problem and ultrasound testing is negative.
• Examination of liver tissue. Your provider may recommend removing a small piece of liver tissue (liver biopsy). Doing so may help your provider understand why your 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 your neck. A thin tube (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 are often treated in the intensive care unit of a hospital in a facility that can perform a liver transplant, if necessary. Your provider may try to treat the liver damage itself, but in many cases, treatment involves controlling complications and giving your liver time to heal.

Acute liver failure treatments may include:

• Medications to reverse poisoning. Acute liver failure caused by acetaminophen overdose is treated with a medication called acetylcysteine. This medication may also help treat other causes of acute liver failure. Mushroom and other poisonings also may be treated with drugs 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 your damaged liver and replaces it with a healthy liver from a donor.

Your provider will also work to control your symptoms and try to prevent complications caused by acute liver failure. Your care may include:

• Relieving pressure caused by excess fluid in the brain. Cerebral edema caused by acute liver failure can increase pressure on your brain. Medications can help reduce the fluid buildup in your brain.
• Screening for infections. Your medical team will take samples of your blood and urine every now and then to be tested for infection. If your provider suspects that you have an infection, you'll receive medications to treat the infection.
• Preventing severe bleeding. Your provider can give you medications to reduce the risk of bleeding. If you lose a lot of blood, tests may be performed to find the source of the blood loss. You may require blood transfusions.
• Providing nutritional support. If you're unable 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 potential future treatments are being explored, it's important to remember they are experimental and may not yet be available.

Among those being studied are:

• 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 is also 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, it 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 time to be evaluated.
• Xenotransplantation. This type of transplant replaces the human liver with one 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.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Preparing for your appointment

If your provider 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 provider:

• What caused my acute liver failure?
• Can it be reversed?
• If it can be reversed, will 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 provider will ask you or your family questions to try to determine the cause of your acute liver failure, including:

• When did symptoms begin?
• What prescription medications do you take?
• What over-the-counter medications do you take?
• What herbal supplements do you take?
• Do you use illegal drugs?
• Have you had liver problems before?
• 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 medications?
• Do you take acetaminophen? How much?
• Do liver problems run in your family?