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Liver transplantation for fulminant liver failure in children
R Mondragon1, G Mieli-Vergani, N D Heaton
1Department of Surgery, King's College Hospital and King's College School of Medicine and Dentistry, London, UK.
Insights
Pediatric liver transplantation offers hope for children with fulminant hepatic failure (FHF), a condition with high mortality. This study shows a 57% survival rate, suggesting transplantation is a viable option when medical recovery is unlikely.
Area of Science:
- Pediatric Hepatology
- Transplantation Surgery
- Critical Care Medicine
Background:
- Fulminant hepatic failure (FHF) in children has a high mortality rate (70-95%) despite medical advancements.
- Liver transplantation is established for adult FHF but infrequently performed in children due to rapid disease progression and donor liver scarcity.
Purpose of the Study:
- To evaluate the efficacy and outcomes of liver transplantation in pediatric patients with FHF.
- To assess the feasibility of liver transplantation as a life-saving intervention for children with poor medical recovery prognosis.
Main Methods:
- Retrospective analysis of seven children (15 months-12 years) undergoing eight liver transplants for FHF between March 1988 and December 1989.
- Etiologies included viral hepatitis (n=5) and drug hepatotoxicity (n=2); five patients presented in grade III-IV coma.
- Reduced-sized grafts were utilized in six procedures.
Main Results:
- Four out of seven patients (57%) survived with a median follow-up of 15 months.
- Post-operative complications included infections (viral, fungal) and abdominal bleeding.
- Mortality causes were graft-versus-host disease (n=2) and brain aspergillosis (n=1).
Conclusions:
- Liver transplantation is a viable therapeutic option for pediatric patients with FHF facing poor chances of medical recovery.
- Despite significant morbidity and mortality, transplantation can achieve survival in a substantial proportion of critically ill children.
- Further research and improved strategies are needed to optimize outcomes in pediatric liver transplantation for FHF.
Abstract:
The mortality rate of fulminant hepatic failure (FHF) in childhood has remained between 70% and 95% despite recent improvements in medical therapy. Liver transplantation has become an important therapeutic option in adults with this entity, but has been infrequently performed in children. Many children do not receive transplants because of the rapid progression of the illness and the lack of suitable donor livers. We present our experience in liver transplantation in children with FHF. Between March 1988 and December 1989, seven children aged between 15 months and 12 years received eight liver transplants. The aetiology of FHF was viral hepatitis in five and drug hepatotoxicity (carbamazepine) in two. Five of our patients were in grade III-IV coma. Reduced-sized livers were used in six of the eight transplants. The post-operative morbidity included viral and fungal infections, and abdominal bleeding. Two patients died from graft-versus-host disease and one from brain aspergillosis. Four patients (57%) survived a median follow-up of 15 months. Liver transplantation should be the therapeutic option in children with FHF where the chances of medical recovery are poor.
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