National Guidelines for the Management of Acute Liver Failure formulated at KIMS

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INASL constituted a Task Force to bring out National Guidelines for the Management of Acute Liver Failure(ALF) which was formulated at Kalinga Institute of Medical Sciences (KIMS). Thirty five experts and liver disease specialists from Delhi, Mumbai, Hyderabad, Chennai, Lucknow, Chandigarh and Bhubaneswar.

All the experts and specialists were the part of the Task Force that was led by Professor Emeritus Dr. S. K. Acharya, Pro-chancellor, KIIT Deemed to be University as  Chairman and Prof.(Dr.) A. C. Anand, Professor and Head, Department of Gastroenterology and Hepatology of KIMS as the Convener. Professor Emeritus Y. K. Chawla, Director of Academics at KIMS is one of senior members and advisers to the task force. Dr. Achutya Samanta, Founder of KIIT, KISS and KIMS welcomed the experts of the Task Force.

Management at a peripheral center was discussed first. A checklist was prepared to outline the management in the resource poor setting.  Importance of intensive care was stressed at all levels. When patients need transfer to a tertiary care center, the precautions to be taken enroute were also discussed and finalized. Special emphasis was given to strategies to prevent cerebral edema which is main killer complication of ALF. Some important aspects of treatment such as plasmapheresis, high volume plasma exchange and artificial liver support were also debated on and their exact role in management was crystallized. Another important aspect of this meeting was discussion on paediatric patients. Paediatric hepatologists were also involved to discuss special requirements in neonate and infants as well as small children.

ALF is the most dangerous liver disease. A healthy young person, if afflicted, may die within few days. India has mainly viral hepatitis induced ALF in contrast to many Western countries, where paracetamol poisoning is the most common cause. It also meant that India also needed a different definition of this disease and some of the classifications described from West may not be relevant in India, opined the experts and specialists.

Decision to transplant liver in a given patient is very crucial one. Patients requiring liver transplantation is a critical decision and how that decision would be made was deliberated upon. Liver transplant surgeons were also a part of the group and management of patient at liver transplant center was also discussed. The deliberation of the consensus meeting will finally be published in an internationally indexed journal.

In fact, Indian National Association for the Study of Liver (INASL) is a National Body comprising of all Liver Disease Specialists. It often issues guidelines for treatment of various liver diseases. So far there were no guidelines for the management of acute liver failure (ALF) in India, although a considerable amount of work has been done in this subject. Not only that, the profile of ALF seen in India also significantly differs from that of western countries.