National guidelines for the management of acute liver failure (ALF) were formulated by experts at the Kalinga Institute of Medical Sciences (KIMS) here on Thursday.
Thirty-five experts and liver disease specialists from Delhi, Mumbai, Hyderabad, Chennai, Lucknow, Chandigarh and Bhubaneswar were the part of the taskforce formed by the Indian National Association for the Study of Liver (INASL). Dr SK Acharya, Pro-Chancellor, KIIT University was its Chairman and Dr AC Anand, Professor and Head, Department of Gastroenterology and Hepatology, KIMS was its convenor. Professor Emeritus YK Chawla, Director Academics at KIMS, was one of senior members and advisers to the taskforce.
They discussed on presentation of acute liver failure (ALF), the most dangerous liver disease, in India terming it as distinctly different to what is described in the Western textbooks. India has mainly viral hepatitis induced ALF in contrast to many Western countries, where paracetamol poisoning is the commonest cause. Thus, India needed a different definition of this disease and some of the classifications described from West may not be relevant in India, they opined.
A healthy young person, if afflicted with ALF, can die within a matter of few days. Decision to transplant liver in a given patient is very crucial one.
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 finalised. 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 crystallised. 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.
KIIT, KISS, KIMS founder Dr Achutya Samanta welcomed the experts.