Perioperative concerns in acute liver failure

Management of patients with ALF is a resource intense endeavor. Those involved in intensive care and perioperative care medicine are central to this process. Mechanisms are not fully understood. ICP monitoring is useful from a practical point of view, but can add to the life-threatening issues. Treatments are often empirical and the quality of the implanted graft is also a confounding variable. Little evidence-based medicine exists because few controlled studies have been possible. Most centers see only a few of these cases per year. Large multicenter and well-designed prospective studies are needed. Where possible, most centers should be willing to contribute to this process. Liver support devices or hepatocyte transplantation will hopefully someday provide the bridge to recovery or transplantation. Even the development of newer anesthetic agents such as xenon may offer important advances.