Epidemiology

Acute liver failure (ALF) is a rare event with fewer than 10 cases per million people per year in the developed world.[7][9]​ ALF was responsible for 1.9% of US liver transplants in 2021.[10]​​​

Due to its rarity and acute presentation, ALF had not been well studied prospectively until the establishment of the US Acute Liver Failure Study Group (ALFSG). Over nearly 20 years, more than 2000 adult patients in over 30 US centres have been enrolled in the ALFSG database.[7][11][12] A separate database has also been established for paediatric ALF cases arising from 19 US, 1 Canadian, and 2 UK centres.

Analysis of the adult dataset has revealed that the majority of cases were women (67%) and the mean age was 38 years (range 17-79 years). The overall rate of spontaneous recovery without liver transplantation was 45%; 25% of cases received a liver transplant; and the overall mortality rate was 30%.[7]

These reported outcomes are an improvement over those described in past decades, partly due to changing trends in aetiologies of ALF. Additional data have revealed improvements in overall short-term survival, transplant-free survival, and post-transplant survival over the last decade in particular, possibly as a result of early recognition and changes in intensive care management.[12]

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