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Semin Liver Dis 2008; 28(2): 137-141
DOI: 10.1055/s-2008-1073113
© Thieme Medical Publishers

Perspectives on Liver Failure: Past and Future

Stephen M. Riordan1 , Roger Williams2
  • 1Gastrointestinal and Liver Unit, The Prince of Wales Hospital and University of New South Wales, Sydney, Australia
  • 2The Institute of Hepatology, Royal Free and University College Medical School, London, United Kingdom
Further Information

Publication History

Publication Date:
02 May 2008 (online)

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ABSTRACT

Acute liver failure (ALF) remains a potentially devastating syndrome with a high mortality rate. Much interest continues to center upon the possibility of providing effective liver support through various artificial and bioartificial extracorporeal devices. The development of purpose-designed intensive care units for the treatment of ALF allowed a better understanding of the clinical syndrome and its best management, through the ability to conduct detailed clinical observation and clinical trials of new interventions. Survival rates are substantially improved today compared with the mortality rate that approximated 100% when the syndrome was first described nearly five decades ago. Nonetheless, these have plateaued in recent years, prompting one to consider whether major new advances in disease understanding are needed to further improve the overall outcome. A major challenge to a broader understanding of disease pathogenesis and the ability to direct appropriate therapy remains the substantial number of cases of ALF for which no specific etiology can be identified. Much is now known about the basic molecular mechanisms underlying hepatocyte cell death in ALF and an important issue is whether these cell death pathways can, in the future, be interrupted for therapeutic gain. Such considerations would seem most relevant in the early stages of the clinical course, when damage to the liver is not so severe but perhaps programmed to so evolve. A particular challenge will be to reduce hepatocellular death without inhibiting the liver's regenerative potential, given the pleiotropic functions of some of the molecules involved in both processes.

KEYWORDS

Acute liver failure - liver support - cell death

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Professor Roger WilliamsM.D. 

Director, The Institute of Hepatology, Royal Free and University College Medical School

69-75 Chenies Mews, London WC1E 6HX, United Kingdom

Email: roger.williams@ucl.ac.uk

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