Acute liver failure (ALF) is a rather rare clinical syndrome developing due to an acute massive dysfunction of the liver cells in previously healthy persons (at least 8 weeks there was no diagnosis of any liver disease) resulting in rapidly progressing multiple organ dysfunction syndrome. Without liver transplantation 80-95 % of the patients die. Factors, influencing the outcome are etiology, the patient's age and the course of the disease. Spontaneous recovery, however, is possible in 5-60 % of ALF cases when regeneration of the liver starts, therefore the main goal of the treatment is to create the most favorable conditions for regeneration. Causes of ALF may be different. The most common cause of ALF is viral hepatitis, but the prevailing causative agent of hepatitis is different in different countries. Drug-induced (acetaminophen, halotane) liver dysfunction ranks second. The order of other etiological factors according to their frequency is: mushroom (Amanita) poisoning, carbon tetrachloride toxicity, heat stroke, synthetic amphetamine ("Ecstasy") and disorders of liver blood vessels. In cases of unfavorable prognosis for patients with ALF the only method of treatment with good prognosis is liver transplantation (LT). From 50 to 70 % of patients with lethal ALF prognosis survive after emergency LT. There is no unified ALF prognostic system or indications for LT in the world, therefore a precise individual prognosis for every patient and well-timed decision about LT are... [to full text]