Acute liver failure (ALF) is a rare condition, associated with high mortality and high healthcare cost. Common causes of acute liver injury leading to ALF are viral infection or specific drugs, with significant geographic variation in epidemiology. The most frequent cause of ALF in the UK is paracetamol (acetaminophen) toxicity. Advances in the critical care management of ALF, as well as surgical techniques and organ selection for transplantation, have improved outcomes for patients with ALF over recent decades. Remaining challenges in the management of ALF relate to the use of intracranial pressure monitoring, the role of therapeutic hypothermia, and advances in living-donor transplantation. Future research will also focus on extracorporeal liver assist devices, and therapies to alter the host immune response to liver injury.
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