Pathology of Acute and Acute-on-Chronic Liver Failure

Clin Liver Dis. 2023 Aug;27(3):581-593. doi: 10.1016/j.cld.2023.03.004. Epub 2023 Apr 23.


Liver failure can develop as either acute liver failure in the absence of preexisting liver disease, or as acute-on-chronic liver failure in a patient with underlying chronic liver disease or cirrhosis. A timely liver biopsy is helpful to distinguish acute and chronic liver disease, identify precipitating factors, provide prognostic information based on pathologic changes, and aid in making appropriate decisions for patient management. This article will discuss the pathologic features of acute and acute-on-chronic liver failure. Developing an appreciation for the histopathologic patterns of injury observed in these entities is essential for a practical understanding of the diagnostic process.

Keywords: Acute liver failure; Acute-on-chronic liver failure; Liver failure; Pathology.

Publication types

  • Review

MeSH terms

  • Acute-On-Chronic Liver Failure* / diagnosis
  • Acute-On-Chronic Liver Failure* / etiology
  • Biopsy
  • Hepatic Insufficiency*
  • Humans
  • Liver Cirrhosis / complications