Written By: Prerna Mittra | Updated : December 13, 2023 7:35 PM IST
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Patients admitted with ALF need a liver transplant once they fulfill the criteria as a "definitive cure". (Photo: Freepik)
Acute liver failure (ALF) is a rare condition that happens when the liver "suddenly begins to lose its ability to function". It can often happen right after an overdose of a medicine, or poisoning, states hopkinsmedicine.org, adding that chronic liver failure happens over a long stretch of time. One Krishna Bhanushali, a resident of Ankleshwar in Gujarat, suffered from ALF -- whose prevalence in India is around 1-2 per cent, and mortality is around 50-75 per cent if not treated timely -- at merely 19 years of age. But, she was able to recover without undergoing a transplant. Here is what happened.
The patient developed jaundice suddenly and became drowsy in three days. Upon examination, it was discovered that she was suffering from ALF. The best chance of survival for her would have been an urgent liver transplant. But, because of progress in liver critical care and intensive care, continuous renal replacement therapy (CRRT) and plasma exchange were used to save her life at Global Hospitals in Parel, Mumbai.
"The patient arrived on November 14, 2023 in an emergency. She was in a comatose condition with very low blood pressure, increased heart rate, and hemodynamically unstable condition. Due to ALF, her blood was thin; she was bleeding spontaneously from nose and mouth. Her ammonia levels were high due to liver failure, causing swelling inside the brain and grade IV coma (hepatic encephalopathy)," said Dr Uday Sanglodkar, senior consultant hepatologist and clinical lead liver and transplant ICU, Global Hospitals, Parel, adding that viral infection (HAV, HEV) is a common culprit, transmitted through unhygienic food and water.
As mentioned earlier, patients admitted with ALF need a liver transplant once they fulfill the criteria as a "definitive cure". "In this patient, the sister was a potential donor; a backup living donor transplant was also planned. We, however, supported her with slow kidney dialysis (CRRT) that helped in the removal of ammonia to decrease the swelling in the brain. She was treated using advanced medical techniques such as CRRT and plasma exchange (PE), eliminating the need for a liver transplant," Dr Sanglodkar explained.
According to the doctor, PE (a type of extracorporeal dialysis) is done wherein the patient's blood containing toxins and harmful waste is replaced with fresh plasma to support the liver and correct coagulation and hemodynamic parameters. "After a week of aggressive treatment, she was off the ventilator, fully awake, shifted to the ward, and now only on oral medication and supportive care. She will be discharged [soon] and can return to her regular activities in two weeks. She needs to follow hygiene practices for food and water," the doctor added.
Advancements in critical liver care technology and intensive care units equipped with machines for CRRT and PE can help avoid the need for transplantation, which is a serious surgery with a long recovery period.
