What is it about?
Fulminant hepatitis (now called acute liver failure) is a rare condition where the liver rapidly fails to perform its numerous vital functions. It has a rapid evolution and a high mortality, unless liver transplantation is performed. Population-based studies are lacking, and the vast majority of data are from Western countries, where the main cause is paracetamol overdose. In low- and middle-income countries, this disease is less rare and often due to viral hepatitis, tropical infections, traditional herbal medicines and anti-tuberculosis drugs. Liver transplantation is much less available, and patients are often admitted to primary hospitals due to lack of, or distance from, specialized centres.
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Why is it important?
In this Review, we have discussed frequency, occurrence in children and pregnant women, prognostic factors, mortality, and treatment in low- and middle-income countries. We have also advocated for multi-country collaboration, establishment of central registries for this disease, and better diagnostics.
Perspectives
Inadequate infrastructure, insufficient numbers of doctors and nurses trained in diagnosing and treating the disease, diagnostics limited by cost are very difficult issues to address to improve assistance to, and outcome of patients with fulminant hepatitis. Supportive and intensive care management, though of limited efficacy and often non-curative, remains the only option that can be offered to patients; therefore, efforts should be made to train doctors and nurses, at least in referral hospitals, to promptly diagnose and appropriately manage the disease. If coupled with improved, better staffed and equipped intensive care units, this could allow to increase the chances of patients’ recovery even in the absence of liver transplantation.
Professor Sandro Vento
Manash Kozybayev North Kazakhstan University
Read the Original
This page is a summary of: Acute liver failure in low-income and middle-income countries, The Lancet Gastroenterology & Hepatology, November 2023, Elsevier,
DOI: 10.1016/s2468-1253(23)00142-5.
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