Treatment of Acute Liver Failure in Resource-Constrained Settings without Transplantation Facilities Can Be Improved

Acute liver failure affects previously healthy and often young people and has a very high mortality due to rapid multi-organ failure. The diagnosis is based on the presence of coagulopathy (International normalized ratio >2 or prothrombin rate <50%) and hepatic encephalopathy within 8 weeks of onset of jaundice in patients with no previous liver disease (1). In resource-constrained developing countries, hepatitis A, B, and E infections, traditional medicines (2), drugs, herbal supplements (3), and halothane (4) are the main causes. Even though liver transplantation is the treatment of choice nowadays, the survival rate without liver transplantation in adults is as high as 40% in high-income countries (5, 6). Unfortunately, it is much lower in developing countries (7) where cases are diagnosed too late or considered untreatable in the absence of a transplant center. We propose a practical approach that can be used in Intensive Care Unit-equipped hospitals in resource-constrained countries to try and reduce the high mortality rate where liver transplantation is not available.