Advances in the management of acute liver failure

Table 1 Drugs which may cause idiosyncratic liver injury leading to acute liver failure

Classification	Drugs
Anti-infective agents	Amoxicillin/clavulanateerythromycin, roxithromycin, telithromycin, doxycycline, minocyclinenitrofurantoin, ciprofloxacin, levofloxacin, moxifloxacintrimethoprim-sulfamethoxazole, sulfasalazine, isoniazid, rifampin, pyrazinamide, ethambutol, dapsone,fluconazole, itraconazole, terbinafine, ketoconazole, chloroquineDidanosine, fialuridine, efavirenz, abacavir, nevirapine-lamivudine
Cardiovascular agents	Amiodarone, labetalol, diltiazem, methyldopa, valsartan, lisinopril, angiotensin converting enzyme inhibitorAsparaginase, flutamide
Hypolipidemic agents	Atorvastatin, cerivastatin, simvastatin, pravastatin, fluvastatin, ezetimibe
Hypoglycemic Agents	Metformin, troglitazone
Anti-allergic agents	Zafirlukast, loratadine, diphenhydramine
Herbal products/dietary supplements	Kava, Herbalife, Comfrey, Senecio, Greater Celandine, Polygonum multiflorum, ginseng, Teucrium polium, usnic acid, ma huang, Chaso, Onshido, Hydroxycut, LipoKinetix
Neurological and psychiatric drugs	Halothane, isoflurane, butorphanolopiates, amphetamines, marijuana, cocainePhenytoin, valproic acid, carbamazepine, felbamate, lamotrigine, vigabatrinamitriptyline, imipramine, sertraline, paroxetine, venlafaxine, pemoline, bupropionChlorpromazine, quetiapine, clonazepamtolcapone
Nonsteroidal anti-inflammatory drugs	Diclofenac, bromfenac, etodolac, naproxen, ibuprofen, indometacin
Miscellaneous	Propylthiouracil, retinol, infliximab, allopurinol, cyclosporine, disulfiram, iron sulfate, anabolic steroids, carbon tetrachloride, phenprocoumon, nicotinic acid
Antineoplastic agents	Methotrexate, cytoxan, etoposide, dactinomycin, azathioprine, tamoxifen

Table 2 King's College criteria for selecting recipients of emergency liver transplants

Acetaminophen-induced ALF	Non-acetaminophen-induced ALF
Strongly recommended list for OLT if: Arterial lactate > 3.5 mmol/L after early fluid resuscitation	List for transplantation if: INR > 6.5 and encephalopathy present irrespective of grade
List for transplantation if: Arterial pH < 7.3 or arterial lactate > 3.0 mmol/L after adequate fluid resuscitation	Or if any 3 of the following features (encephalopathy irrespective of grade) are present:
	Age < 10 yr or > 40 yr1
	Interval from jaundice to encephalopathy > 7 d1
List for transplantation if all 3 of the following occur within a 24-h period: Grade 3 or 4 hepatic encephalopathy INR > 6.5 Creatinine > 300 μmol/L	INR ≥ 3.5
	Serum bilirubin ≥ 300 μmol/L
	Unfavorable etiology, such as seronegative hepatitis, idiosyncratic drug reaction or Wilson disease

¹These criteria have not been found to be predictive of outcome in recent analyses. ALF: Acute liver failure; OLT: Orthotopic liver transplantation; INR: International normalized ratio.