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Emergency liver transplantation for fulminant liver failure in infants and children
D Devictor1, L Desplanques, D Debray
1Unité de Réanimation Pédiatrique, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Emergency liver transplantation can be effective for children with acute liver failure. Early transfer to a transplant center before hepatic encephalopathy improves outcomes for pediatric fulminant liver failure patients.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Transplant Surgery
- Critical Care Medicine
Background:
- Fulminant liver failure (FLF) in children presents a critical medical emergency.
- Identifying suitable candidates for liver transplantation is crucial for survival.
- Timely intervention is key in managing pediatric FLF.
Purpose of the Study:
- To evaluate the outcomes of orthotopic liver transplantation in children with FLF.
- To assess the efficacy of established criteria for selecting pediatric FLF patients for transplantation.
- To highlight the importance of early referral for pediatric liver transplantation.
Main Methods:
- Retrospective analysis of 35 children with FLF evaluated for orthotopic liver transplantation.
- Application of criteria including hepatic encephalopathy and Factor V levels (<25%) for transplant candidacy.
- Tracking of patient outcomes including spontaneous recovery, mortality, and post-transplant survival.
Main Results:
- Viral hepatitis was the leading cause (54.2%) of FLF in children.
- 20% of children recovered spontaneously, while 17.1% had contraindications and died.
- Of 22 children meeting criteria, 19 underwent transplantation with a 68.4% survival rate at follow-up.
Conclusions:
- Orthotopic liver transplantation is an effective treatment for pediatric FLF.
- Early identification and transfer to a transplant center are vital to prevent irreversible brain damage and improve survival.
- Transplantation before the onset of severe hepatic encephalopathy significantly impacts patient outcomes.
Abstract:
We report our results with orthotopic liver transplantation in children with fulminant liver failure. Thirty-five children with fulminant liver failure were evaluated for liver transplantation. The main causes of liver failure were viral hepatitis (54.2%), drug-induced liver injury (14.2%) and Wilson's disease (11.4%). Children were considered as candidates for liver transplantation only if hepatic encephalopathy was associated with a decrease in the level of factor V to below 25%. Seven children (20%) did not meet this criterion and recovered spontaneously. Six children (17.1%) had contraindications for liver transplantation and died. In three of these six children, contraindications included irreversible brain damage at the time of admission. Twenty-two children (62.8%) met the criteria for liver transplantation and were placed on the emergency transplant list. Three of them died awaiting grafts. Nineteen children underwent liver transplantation; 13 of them (68.4%) are alive without sequelae, after 6 mo to 4 yr of follow-up, at this writing. Four of the children who died after surgery had severe encephalopathy on admission that did not improve after liver transplantation. In conclusion, emergency liver transplantation appears to be an effective treatment for children with fulminant liver failure. Nevertheless, irreversible brain damage developed in 10 patients, and they died before or after surgery. We postulate that many of these deaths could have been avoided if children had been transferred to a liver transplantation facility and had undergone transplantation earlier. We emphasize that children with acute liver failure should be transferred to a center that performs liver transplantation before the development of hepatic encephalopathy.