Guide to Acute Liver Failure
Reviewed by the physicians of Columbia’s Liver Transplant Team, January 2024
Acute liver failure is a rare condition in which the liver rapidly deteriorates and stops functioning within a matter of days. Because it can develop so quickly, often in people with no pre-existing liver disease, it is considered a life-threatening condition.
Key Facts
- While other liver conditions take months or years to destroy the liver, acute liver failure takes only days.
- It can be caused by overdosing on medication or ingesting toxic substances, and often affects those with no pre-existing liver conditions.
- Medications can treat acute liver failure caused by overdoses and toxins. In many other cases, a liver transplantation is required.
Causes
The following are some of the most common causes of acute liver failure:
- Acetaminophen: Overdosing on acetaminophen (such as Tylenol) is the most common cause of acute liver failure in the U.S.
- Cancer: Cancer that begins or spreads to the liver can cause acute liver failure.
- Herbal Medications: Common herbs such as aloe vera, chaparral, comfrey, ephedra, and kava can be toxic to the liver.
- Hepatitis: In rare cases, hepatitis A, B, and E, as well as autoimmune hepatitis, can all cause acute liver failure.
- Metabolic Diseases: Rare conditions such as Wilson’s disease can cause acute liver failure.
- Prescription Medications: Drug-induced acute liver failure can be caused by various medications, such as antibiotics, nonsteroidal anti-inflammatories, and anticonvulsants.
- Toxins: Poisonous mushrooms are one toxin that can cause acute liver failure.
- Vascular Diseases: These include Budd-Chiari syndrome, which can block the veins in the liver.
Symptoms
The following are some of the most common symptoms of acute liver failure:
- Abdominal pain
- Disorientation, confusion, and/or an inability to concentrate
- General malaise
- Jaundice (yellowing of skin and eyes)
- Nausea
- Sleepiness
- Vomiting
Because many of these symptoms can be associated with other conditions, it can be difficult to detect signs of acute liver failure. However, if you develop jaundice or unusual changes in your mental state, go to a doctor immediately. Acute liver failure can develop quickly and can be fatal.
Diagnosis
The following are the most common ways to diagnose acute liver failure:
- Blood Tests: These will determine the degree of liver injury and how well the liver is functioning. A prothrombin time test, which measures how long it takes blood to clot, is a very common exam. Other tests may measure levels of bilirubin, lactate (lactic acid), and liver enzymes.
- Imaging Tests: This will usually include an ultrasound, which uses soundwaves to form an image of the liver so that doctors can detect a potential cause of liver damage. Other tests may include a computerized tomography (CT) scan and magnetic resonance imaging (MRI). Both help doctors look for other causes of acute liver failure when the ultrasound is normal.
- Liver Biopsy: This is a procedure that removes a tiny portion of liver tissue so that doctors can examine it under a microscope to determine what is wrong.
In addition to these tests, doctors may also ask about recent symptoms, medications, and factors that put the patient at risk of viral hepatitis.
Treatment
Depending on its cause, there are two treatments for acute liver failure: medication and transplantation. Because acute liver failure can develop so quickly and is fatal, it is vital to seek treatment immediately.
Medication
When acute liver failure is caused by ingesting toxic substances, acetaminophen overdose, or viral hepatitis, it can often be treated through medication. These include the following:
- Activated Charcoal: This is carbon that has been exposed to high temperatures, which increases its surface area and makes it effective at absorbing toxins.
- Antiviral Therapy: This encompasses medications that will slow down the effects of the hepatitis virus. The most common agents include entecavir (Baraclude) and tenofovir (Viread).
- N-Acetyl Cysteine: This is a derivative of amino acid that is highly effective in treating the effects of acetaminophen overdoses, as well as mushroom poisoning.
- Penicillin: When given in high doses, this common antibiotic can combat toxins such as mushrooms.
Transplantation
For many other cases of acute liver failure, a liver transplantation is the only treatment option. This involves removing the diseased liver and replacing it with a healthy donor liver.
Because of how quickly acute liver failure can progress, patients who are eligible for a liver transplantation will be given a “status one” classification on the transplant waiting list. This lets them bypass other patients and receive a donor liver much sooner, often within just 48 to 72 hours.
Learn more about liver transplantations here.
Outlook
Due to its rapid development, acute liver failure is often fatal if not treated as soon as possible. However, with timely medical attention, it’s often possible to make a full recovery.
After Medication
Patients who develop acute liver failure after overdosing on acetaminophen, ingesting toxins, or contracting hepatitis and who begin a medication regimen soon enough (within 48 hours of signs or symptoms of the disease) typically are able to reverse the condition and regain their health.
After Transplantation
Patients who undergo a liver transplantation also typically enjoy excellent outcomes. According to data compiled by the Organ Procurement and Transplantation Network (OPTN/SRTR), the national survival rate for deceased donor liver transplants performed between 2015 and 2020 was:
- 92.2 percent one year after surgery
- 86.7 percent three years after surgery
- 81.4 percent five years after surgery
Patients who undergo a liver transplantation will need to take a variety of medications, such as immunosuppressants, for the rest of their lives to ensure their new liver continues to function normally.
Preventing Recurrence
Acute liver failure is a rare condition and is extremely unlikely to recur.
However, chronic diseases like hepatitis can come back, which will increase the likelihood of developing liver disease again. Fortunately, antiviral medications have been developed that have led to significantly improved outcomes for viral hepatitis patients. Regardless, patients at risk of recurrence should still remain under close medical observation to reduce the chance of additional infection.
Next Steps
If you think you or someone you know may have acute liver failure, seek medical attention immediately. Call us at (877) LIVER MD/ (877) 548-3763 or use our online form to schedule an appointment.
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