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Published on: November 27, 2019
Approaches to acute liver failure in children
Anil Dhawan1, Paul Cheeseman, Giorgina Mieli-Vergani
1Institute of Liver Studies, King's College Hospital, Denmark Hill, London, UK.
Insights
Acute liver failure (ALF) in children is a serious condition with unknown causes in many cases. Management focuses on supportive care and timely liver transplantation when necessary, with specific predictors of outcome identified.
Area of Science:
- Pediatric Hepatology
- Critical Care Medicine
- Transplantation Surgery
Background:
- Acute liver failure (ALF) is a rare, life-threatening condition in children.
- Etiologies are diverse, including infections, toxins, metabolic disorders, and autoimmune diseases, with many cases remaining idiopathic.
- Hepatic encephalopathy presentation differs from adults, potentially being a late or absent feature in pediatric ALF.
Purpose of the Study:
- To review the management of pediatric acute liver failure.
- To discuss the role and criteria for liver transplantation in children with ALF.
- To highlight predictors of outcome and future therapeutic directions.
Main Methods:
- Review of existing literature and clinical experience in managing pediatric ALF.
- Analysis of factors influencing prognosis and the decision-making process for liver transplantation.
- Identification of reliable indicators for predicting patient outcomes.
Main Results:
- Liver transplantation is a critical option for pediatric ALF when the underlying cause is untreatable and transplant prognosis is favorable.
- Established criteria for liver transplantation listing are lacking, necessitating center-specific guidelines.
- Maximum INR, bilirubin level, white cell count, and age are identified as reliable predictors of outcome in pediatric ALF.
Conclusions:
- Pediatric ALF requires management in specialized centers with liver transplant capabilities.
- Supportive care is crucial to allow potential liver regeneration, with transplantation reserved for specific indications.
- Future research should focus on developing effective non-transplant therapies and supportive strategies for pediatric ALF.
Abstract:
Acute liver failure (ALF) is a rare but often fatal disorder in childhood. Its aetiology includes infections, toxins, metabolic disorders, infiltrative diseases, autoimmune hepatitis, ischaemia, irradiation damage, but in a high proportion of cases it remains unknown. In contrast to adults, in children with ALF hepatic encephalopathy can be a late event, and may not develop at all, despite a lethal outcome, particularly in infants. Children with ALF should be managed in experienced centres with facilities for liver transplantation. Transplantation should be offered only if the underlying disease is treatable by liver replacement and if the prognosis of transplant is better than that of the underlying disease, as in many cases of ALF the liver has the potential to recover with supportive treatment, if the child is kept alive and stable long enough. Universally accepted criteria for listing for transplantation have not been defined as yet. In our centre, maximum INR, bilirubin level, and white cell count, together with age have proven to be reliable predictors of outcome. Future efforts in the management of ALF should concentrate on designing efficient supportive therapy and specific treatments to provide effective non-transplant therapeutic options.
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