Mechanisms of Hepatocyte Injury, Multiorgan Failure, and Prognostic Criteria in Acute Liver Failure

Stephen M. Riordan; Roger Williams

doi:10.1055/s-2003-42639

Seminars in Liver Disease, Table of Contents

Semin Liver Dis 2003; 23(3): 203-216
DOI: 10.1055/s-2003-42639

Mechanisms of Hepatocyte Injury, Multiorgan Failure, and Prognostic Criteria in Acute Liver Failure

Stephen M. Riordan¹ , Roger Williams²

¹Associate Professor of Medicine Director of Hepatology Gastrointestinal and Liver Unit. The Prince of Wales Hospital University of New South Wales Sydney, Australia
²Professor of Hepatology and Director, Institute of Hepatology, University College London and Honorary Consultant Physician, University College London Hospitals, London, United Kingdom

Abstract

ABSTRACT

Acute liver failure (ALF) occurs when the rate and extent of liver cell death are not adequately balanced by regenerative activity. Two forms of liver cell death are recognized: apoptosis and necrosis. A number of causes of ALF have been shown, predominantly in experimental animal models, to induce one or the other form of liver cell death. Nonetheless, an insult capable of inducing apoptosis may cause cell death by necrosis, particularly if the degree of mitochondrial damage is sufficient to exhaust stores of adenosine triphosphate. Here we consider mechanisms of liver cell injury in ALF, including evolving knowledge of signaling pathways leading to hepatocellular apoptosis and necrosis. Factors that have an impact on the adequacy of hepatic regeneration along with the pathophysiology of complicating multiorgan failure are also reviewed. Prognostic criteria are discussed, especially in relation to current concepts of mechanisms of liver cell death and multiorgan dysfunction.

KEYWORDS

Apoptosis - necrosis - regeneration - prognosis

Full Text

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