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Liver transplantation for fulminant hepatic failure and late-onset hepatic failure in children
K C Tan1, R S Mondragon, V Vougas
1Department of Surgery, King's College Hospital, London, UK.
Insights
Pediatric liver transplantation offers a life-saving option for children with fulminant hepatic failure (FHF) and late-onset hepatic failure (LOHF). This study shows a survival rate of 67% in children undergoing liver transplants for these critical conditions.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Critical Care Medicine
Background:
- Fulminant hepatic failure (FHF) and late-onset hepatic failure (LOHF) in children carry a high mortality rate (70-95%).
- Liver transplantation is an established therapy for adults but infrequently used in pediatric cases.
Purpose of the Study:
- To evaluate the efficacy and outcomes of liver transplantation in children with FHF or LOHF.
- To assess the feasibility of reduced-size liver grafts in pediatric recipients.
Main Methods:
- A cohort of 12 children (1 month to 14 years) received 13 liver transplants between March 1988 and August 1991.
- Reduced-size grafts were utilized in 10 out of 13 procedures.
- Etiologies included viral hepatitis, drug toxicity, autoimmune hepatitis, and congenital hemochromatosis.
Main Results:
- Eight out of twelve patients (67%) survived after a median follow-up of 18 months.
- Common morbidities included infections and abdominal bleeding.
- Mortality causes were graft-versus-host disease (2), brain aspergillosis (1), and graft infarction (1).
Conclusions:
- Liver transplantation is a viable and potentially life-saving therapeutic option for pediatric patients with FHF and LOHF.
- Improved outcomes suggest that early consideration of transplantation is crucial for children with poor recovery prognosis.
Abstract:
The mortality rate of fulminant hepatic failure (FHF) and late-onset hepatic failure (LOHF) in childhood has remained between 70 and 95 per cent despite recent improvements in medical therapy. Liver transplantation has become an important therapeutic option in adults with this condition but has been performed infrequently in children. Between March 1988 and August 1991, 12 children aged between 1 month and 14 years with FHF or LOHF received 13 liver transplants. The aetiology was viral hepatitis in eight children (non-A non-B in six, A in two), drug hepatotoxicity (carbamazepine) in two, autoimmune hepatitis in one and congenital haemochromatosis in one. Reduced-size livers were used for ten of the 13 transplants. Morbidity after operation included infective complications and abdominal bleeding. Two patients died from graft versus host disease, one from brain aspergillosis and another from graft infarction after portal vein thrombosis. Eight patients survive after a median follow-up of 18 months. Liver transplantation should be the therapeutic choice for children with FHF and LOHF for whom the chances of recovery are poor.