ALF Study Group continues to shed light on acute liver failure

Liz Meszaros, MDLinx | March 30, 2017

After 20 years, a research effort known as the Acute Liver Failure Study Group (ALFSG) has recruited its 3,000th participant.

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William M. Lee, MD, professor, internal medicine, UT Southwestern, Dallas, TX, and a world-renowned liver disease expert.

The ALFSG is a multicenter study that is active at 12 sites in the United States and Canada, which has gathered information over the past 2 decades in hopes of providing clinicians with a better picture of acute liver failure (ALF) and how it can best be treated. In addition, researchers are also examining how acetaminophen poisoning has replaced other causes, such as hepatitis and other drug poisonings, to become the #1 cause of ALF in the US.

Begun in 1997 upon receiving grants from the National Institutes of Health, the ALFSG was started by principal investigator, William M. Lee, MD, professor, internal medicine, UT Southwestern, Dallas, TX, and a world-renowned liver disease expert. Since then, funding has been taken over by the National Institutes of Health's (NIH) National Institute of Diabetes and Digestive and Kidney Diseases, and they will support the ALFSG through 2020.

“ALF is extremely rare, with only about 2,000 cases in the US each year,” said Dr. Lee, who holds the Meredith Mosle Chair in Liver Disease in his honor. “Because of its rarity, many physicians aren’t that familiar with this rapidly progressive and fatal liver disease and may not recognize it quickly.”

According to Dr. Lee, immediate diagnosis is vital, and N-acetylcysteine (NAC), the only proven antidote, must be given within 12 hours of taking acetaminophen for maximum protection. Waiting too long can cause brain edema, coma, extensive liver damage, need for transplant, and even death.

Since its inception in 1997, the group has published 94 papers on ALF. Important findings from a 2009 study showed that NAC is effective for treating ALF caused by drugs other than acetaminophen. In 2016, study results demonstrated that patients with acetaminophen poisoning were more likely to die within 48 hours compared with those who experience other causes of liver failure. In another study from the same year, these researchers found that ALF patients are currently more likely to survive and less likely to require liver transplant compared with those from previous years, perhaps due to more effective management in intensive care units of these patients.

One of the most practical and useful things to come out of the research group is a free iPhone app, developed in 2014, that gives physicians guidelines for proper diagnosis and treatment of ALF. In 2016, a second free app was launched to help clinicians assess prognosis, and determine whether a liver transplant will be necessary. The apps—“Acute Liver Failure Prognosis Model” and “ALF Checklist”—are currently available at the iPhone app store.

The group’s ongoing research includes a test for the rapid detection of the toxic byproducts of acetaminophen poisoning, which could be available in 2 to 3 years, as well as a new medication to treat all forms of ALF.

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