Despite progress in understanding the underlying mechanisms, acute liver failure (ALF) is still one of the major clinical challenges in hepatology. A wide variety of aetiologies, and similarly, variable courses of the disease, make it crucial to identify the cause of ALF in each individual patient. Conservative therapy is only available for some patients; for many others, liver transplantation remains the only curative option for ALF. Thus, early evaluation and prognostication of the ALF syndrome is warranted for a timely decision to list a patient for transplantation or even as high urgency. This review aims to compose our current knowledge on epidemiology, mechanisms, and prognosis in ALF, and to give a perspective for future studies in this field.
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