Akutes Leberversagen

Kernaussagen

• Das akute Leberversagen (ALV) ist ein seltenes und lebensbedrohliches Krankheitsbild mit einem plötzlichen Verlust der Leberfunktion ohne eine vorbestehende Lebererkrankung.

• Die medikamentös-toxisch induzierte Leberschädigung (v. a. Paracetamol) und hepatotrope Viren sind in den westlichen Industrieländern am häufigsten verantwortlich für ein ALV. Beim ALV unklarer Genese sollte man differenzialdiagnostisch eine Autoimmunhepatitis in Betracht ziehen.

• Die Lebertransplantation ist derzeit die einzige kurative Therapie. Daher sollte man bei Patienten mit ALV umgehend mit einem Transplantationszentrum Kontakt aufnehmen.

• Literatur

• 1 Lee WM, Squires Jr RH, Nyberg SL et al. Acute liver failure: Summary of a workshop. Hepatology 2008; 47: 1401-1415
• 2 Polson J, Lee WM. AASLD position paper: the management of acute liver failure. Hepatology 2005; 41: 1179-1197
• 3 Ostapowicz G, Fontana RJ, Schiodt FV et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137: 947-954
• 4 Bernal W, Auzinger G, Dhawan A et al. Acute liver failure. Lancet 2010; 376: 190-201
• 5 Jalan R, Hayes PC. Hepatic encephalopathy and ascites. Lancet 1997; 350: 1309-1315
• 6 Haussinger D, Schliess F. Pathogenetic mechanisms of hepatic encephalopathy. Gut 2008; 57: 1156-1165
• 7 Lisman T, Leebeek FW, De Groot PG. Haemostatic abnormalities in patients with liver disease. J Hepatol 2002; 37: 280-287
• 8 Stravitz RT, Kramer AH, Davern T et al. Intensive care of patients with acute liver failure: recommendations of the U.S. Acute Liver Failure Study Group. Crit Care Med 2007; 35: 2498-2508
• 9 Canbay A, Tacke F, Hadem J et al. Acute liver failure: a life-threatening disease. Dtsch Arztebl Int 2011; 108: 714-720
• 10 Canbay A, Jochum C, Bechmann LP et al. Acute liver failure in a metropolitan area in Germany: a retrospective study (2). Z Gastroenterol 2009; 47: 807-813
• 11 Hadem J, Stiefel P, Bahr MJ et al. Prognostic implications of lactate, bilirubin, and etiology in German patients with acute liver failure. Clin Gastroenterol Hepatol 2008; 6: 339-345
• 12 Acharya SK, Dasarathy S, Kumer TL et al. Fulminant hepatitis in a tropical population: clinical course, cause, and early predictors of outcome. Hepatology 1996; 23: 1448-1455
• 13 Bhatia V, Singhal A, Panda SK et al. A 20-year single-center experience with acute liver failure during pregnancy: is the prognosis really worse?. Hepatology 2008; 48: 1577-1585
• 14 Sheng L, Soumillion A, Beckers N et al. Hepatitis G virus infection in acute fulminant hepatitis: prevalence of HGV infection and sequence analysis of a specific viral strain. J Viral Hepat 1998; 5: 301-306
• 15 Harma M, Hockerstedt K, Lautenschlager I. Human herpesvirus-6 and acute liver failure. Transplantation 2003; 76: 536-539
• 16 Feranchak AP, Tyson RW, Narkewicz MR et al. Fulminant Epstein-Barr viral hepatitis: orthotopic liver transplantation and review of the literature. Liver Transpl Surg 1998; 4: 469-476
• 17 Sokal EM, Melchior M, Cornu C et al. Acute parvovirus B19 infection associated with fulminant hepatitis of favourable prognosis in young children. Lancet 1998; 352: 1739-1741
• 18 Begriche K, Massart J, Robin MA et al. Drug-induced toxicity on mitochondria and lipid metabolism: mechanistic diversity and deleterious consequences for the liver. J Hepatol 2011; 54: 773-794
• 19 Au JS, Navarro VJ, Rossi S. Review article: Drug-induced liver injury--its pathophysiology and evolving diagnostic tools. Aliment Pharmacol Ther 2011; 34: 11-20
• 20 Craig DG, Ford AC, Hayes PC et al. Systematic review: prognostic tests of paracetamol-induced acute liver failure. Aliment Pharmacol Ther 2010; 31: 1064-1076
• 21 Broussard CN, Aggarwal A, Lacey SR et al. Mushroom poisoning – from diarrhea to liver transplantation. Am J Gastroenterol 2001; 96: 3195-3198
• 22 Korman JD, Volenberg I, Balko J et al. Screening for Wilson disease in acute liver failure: a comparison of currently available diagnostic tests. Hepatology 2008; 48: 1167-1174
• 23 Stravitz RT, Lefkowitch JH, Fontana RJ et al. Autoimmune acute liver failure: proposed clinical and histological criteria. Hepatology 2011; 53: 517-526
• 24 Ochs A. Acute hepatic vascular complications. Internist (Berl) 2011; 52: 795-800, 802
• 25 Hay JE. Liver disease in pregnancy. Hepatology 2008; 47: 1067-1076
• 26 Schror K. Aspirin and Reye syndrome: a review of the evidence. Paediatr Drugs 2007; 9: 195-204
• 27 O’Grady JG, Alexander GJ, Hayllar KM et al. Early indicators of prognosis in fulminant hepatic failure. Gastroenterology 1989; 97: 439-445
• 28 Bernuau J, Goudeau A, Poynard T et al. Multivariate analysis of prognostic factors in fulminant hepatitis B. Hepatology 1986; 6: 648-651
• 29 Cornberg M, Protzer U, Petersen J et al. Prophylaxis, diagnosis and therapy of hepatitis B virus infection – the German guideline. Z Gastroenterol 2011; 49: 871-930
• 30 Ichai P, Duclos-Vallee JC, Guettier C et al. Usefulness of corticosteroids for the treatment of severe and fulminant forms of autoimmune hepatitis. Liver Transpl 2007; 13: 996-1003
• 31 Acharya SK, Bhatia V, Sreenivas V et al. Efficacy of L-ornithine L-aspartate in acute liver failure: a double-blind, randomized, placebo-controlled study. Gastroenterology 2009; 136: 2159-2168
• 32 Bernal W, Hall C, Karvellas CJ et al. Arterial ammonia and clinical risk factors for encephalopathy and intracranial hypertension in acute liver failure. Hepatology 2007; 46: 1844-1852
• 33 Stravitz RT. Critical management decisions in patients with acute liver failure. Chest 2008; 134: 1092-1102
• 34 Murphy N, Auzinger G, Bernel W et al. The effect of hypertonic sodium chloride on intracranial pressure in patients with acute liver failure. Hepatology 2004; 39: 464-470
• 35 Eefsen M, Dethloff T, Frederiksen HJ et al. Comparison of terlipressin and noradrenalin on cerebral perfusion, intracranial pressure and cerebral extracellular concentrations of lactate and pyruvate in patients with acute liver failure in need of inotropic support. J Hepatol 2007; 47: 381-386
• 36 Hadem J, Schneider AS, Manns MP. Acute liver failure. How much diagnostic work-up and therapy does my patient need?. Internist (Berl) 2011; 52: 804
• 37 Jalan R, Olde Damink SW, Deutz NE et al. Moderate hypothermia in patients with acute liver failure and uncontrolled intracranial hypertension. Gastroenterology 2004; 127: 1338-1346
• 38 Plauth M, Cabre E, Riggio O et al. ESPEN Guidelines on Enteral Nutrition: Liver disease. Clin Nutr 2006; 25: 285-294
• 39 Kachaamy T, Bajaj JS. Diet and cognition in chronic liver disease. Curr Opin Gastroenterol 2011; 27: 174-179
• 40 Mas A, Rodes J. Fulminant hepatic failure. Lancet 1997; 349: 1081-1085
• 41 Rolando N, Harvey F, Brahm J et al. Fungal infection: a common, unrecognised complication of acute liver failure. J Hepatol 1991; 12: 1-9
• 42 Wauters J, Wilmer A. Albumin dialysis: current practice and future options. Liver Int 2011; 31 (Suppl. 03) 9-12
• 43 Wang MM, Chen SJ, Ye QF et al. Liver support therapy with molecular adsorbents recirculating system in liver failure: a summary of 252 cases from 14 centers in China. Chin Med J (Engl) 2008; 121: 2197-2201