When the liver is failing, time is of the essence. At the Center for Liver Diseases at the University of Chicago Medicine, we have a team of highly experienced specialists dedicated to helping adults with liver failure. When liver failure is suspected, we work together to recommend the best approach for you or your loved one.

Whenever there is a treatment for the cause of your liver failure, we will start that treatment immediately. However, in many cases, the definitive treatment for liver failure is a liver transplant. Unlike kidney failure where dialysis can be used to do the function of the kidney, there are no machines available yet to replace the work of the liver.

To determine whether you or your loved one is a candidate for a transplant, we have a fast-tracked, comprehensive evaluation protocol for patients in liver failure. Every member of our team is alerted to the urgency of your situation, and we rapidly conduct all the necessary tests and evaluations, which can be completed in two to three days in the inpatient setting. Our patients who are candidates can get on the waitlist faster and, therefore, receive an organ sooner.

Learn more about the liver transplant process.

What is liver failure?

Liver failure means your liver is shutting down or has shut down. The liver handles a number of important functions in the body, including getting rid of harmful substances, producing proteins that allow for adequate clotting, and making bile, which is needed to digest food.

When the liver is failing, it can no longer complete these vital tasks. As a result, the body does not work properly. As liver failure progresses, you may experience some or all of the following symptoms:

  • Jaundice, or yellow eyes and skin
  • Confusion or other mental difficulties
  • Swelling in the belly, arms or legs
  • Severe fatigue
  • A tendency to bleed easily

What is the difference between acute and chronic liver failure?

Liver failure can develop slowly or rapidly, depending on the cause and the condition of the liver.

Chronic liver failure: The most common type of liver failure is chronic, which can take months or years to develop. Chronic liver failure is a slow decline in liver function that occurs alongside cirrhosis, or severe scarring of the liver. Cirrhosis may be caused by excess alcohol intake, hepatitis, nonalcoholic fatty liver disease, bile duct diseases and various hereditary conditions.

At UChicago Medicine, our liver disease team helps hundreds of patients a year with cirrhosis. We focus on controlling or slowing the progression of cirrhosis with lifestyle changes, medicines and other treatments.

Over time, however, cirrhosis can slowly lead to a decline in liver function and, ultimately, liver failure. We perform periodic testing to monitor the health of your liver so we will know if and when your liver begins to fail. Once cirrhosis progresses to liver failure, the definitive treatment is a liver transplant.

Acute liver failure: When liver failure develops rapidly, typically over days to a few weeks, it is known as acute liver failure. This form of liver failure is rare and often happens in people who have never had previous liver problems. Causes of acute liver failure include:

  • Taking too much acetaminophen or combining acetaminophen with alcohol use
  • Hepatitis (A, B and autoimmune)
  • Ingesting toxins, such as poisonous mushrooms
  • Unexpected liver toxicity from medications
  • Certain diseases, including Budd-Chiari syndrome and Wilson’s disease

Acute liver failure is considered a medical emergency. Patients suffering from acute liver failure are monitored in our state-of-the-art intensive care units. Treatment will depend on the cause of your underlying liver failure. Medications may help treat hepatitis, acetaminophen overdoses, poisonings and other causes. If treatment is not effective, you or your loved one will be evaluated for a possible liver transplant.

Acute-on-chronic liver failure: Sometimes people with chronic liver failure who are clinically stable suddenly develop rapid progression of the liver failure. There are various causes for the rapid worsening of the liver function, including an infection, drinking some alcohol despite having a cirrhotic liver or ingesting medications that may unexpectedly harm the liver.

What treatments are available for liver failure?

Patients with acute-on-chronic liver failure may see their livers fail over weeks to months, compared to months to years as is typical in chronic liver failure.

As with acute liver failure, we focus first on treating the underlying cause of sudden liver failure before considering a possible liver transplant.

In many cases, the only treatment for liver failure is a liver transplant. However, liver failure is sometimes brought on by an acute or hereditary cause that can be treated. For instance, when liver failure is caused by ingesting too much acetaminophen (an over-the-counter pain reliever), we will use medicine to counteract the effects of this common drug to reduce liver damage. When liver failure results from a hereditary copper-overload disease, we will use medications to remove the copper out of the body. Or when liver failure is precipitated by an infection in patients with cirrhosis, we will use antibacterial medicines to fight the infection to, hopefully, return the liver to its previous functional state.

Frequently Asked Questions about Liver Failure

Early on, liver damage may not cause any symptoms. A failing liver is usually detected with blood tests. Over time, you may notice jaundice and other symptoms highlighted above.

Liver failure is when the liver has shut down or is shutting down. Cirrhosis is a late stage of liver disease where the liver is severely scarred but may still be able to perform its function to support life. When the liver is no longer able to perform its work adequately, its goes into liver failure. Most patients who develop chronic liver failure have underlying cirrhosis. Liver disease can go through these stages:

  • Inflammation: Increased activity of the immune system in the liver, leading to swelling of the liver
  • Fibrosis: Early scarring that can follow inflammation in the liver
  • Cirrhosis: Severe scarring of the liver that accumulates with prolonged inflammation and typically cannot be reversed
  • End-stage liver disease: Little to no liver function (often called liver failure)

A liver with no cirrhosis has a high capacity to regenerate itself. If patients follow treatment recommendations, their livers can regain normal function. Treatment often involves adopting healthy behaviors, such as reducing alcohol intake for people with alcoholic liver disease or weight reduction for those with nonalcoholic fatty liver disease that is precipitated by excess weight.

However, once cirrhosis develops, there’s little chance that the liver can repair itself.

One of the ways we determine if your liver is failing is through blood tests, which helps us determine your MELD score, or Model for End-Stage Liver Disease score. We look at four lab results:

  • Bilirubin, which tells how well your liver is expelling bile
  • Creatinine, which reflects the kidney function, an organ that is affected by liver failure
  • INR or prothrombin time, which measures the function of blood-clotting factors produced by the liver
  • Sodium, which is an electrolye in the blood that is affected by advanced liver disease

Your MELD score will range from 6 to >40. The worse your liver function, the higher your MELD score will be, and the higher your risk of death. The MELD score is also used to determine a person’s priority on the transplant list, with sicker patients receiving higher priority. The MELD score can be calculated using a programmed equation.

Dr. Fung and Dr. Charlton, co-directors of the transplant institute

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