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Published on: November 27, 2019
Prognostic modeling in pediatric acute liver failure
1Paediatric Liver, GI and Nutrition Centre, King's College Hospital, London, UK.
Insights
Developing accurate prognostic models for pediatric acute liver failure (PALF) is crucial. These models aim to prevent unnecessary liver transplantation (LT) in children who may spontaneously recover, optimizing organ allocation.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Transplantation Medicine
Background:
- Liver transplantation (LT) is the primary treatment for pediatric acute liver failure (PALF).
- Increasing reports of spontaneous native liver survival raise concerns about potential over-transplantation in children with acute liver failure (ALF).
- A validated prognostic model is needed to guide organ allocation, distinguishing between patients requiring LT and those likely to recover spontaneously.
Purpose of the Study:
- To review the challenges in developing prognostic models for PALF.
- To discuss current and emerging predictive methods for PALF.
- To improve decision-making regarding LT in pediatric ALF.
Main Methods:
- Review of existing literature on prognostic modeling in PALF.
- Analysis of challenges including age/etiology heterogeneity and natural history.
- Discussion of identified laboratory variables and scoring systems.
- Mention of a validated prognostic model for ALF in Wilson's disease.
- Exploration of physiological, immunological, and metabolomic parameters.
Main Results:
- Prognostic model development for PALF is complex due to disease heterogeneity and limited understanding of natural history.
- Several laboratory variables have shown prognostic value.
- Targeted models, like one for Wilson's disease, have been developed and validated.
- Ongoing research investigates broader physiological, immunological, and metabolomic markers.
Conclusions:
- Accurate prognostic models are essential for optimizing liver transplantation decisions in pediatric acute liver failure.
- Overcoming challenges in PALF heterogeneity is key to developing reliable predictive tools.
- Future research focusing on diverse parameters will enhance prognostic accuracy and patient care.
Abstract:
Liver transplantation (LT) is the only proven treatment for pediatric acute liver failure (PALF). However, over a period of time, spontaneous native liver survival is increasingly reported, making us wonder if we are overtransplanting children with acute liver failure (ALF). An effective prognostic model for PALF would help direct appropriate organ allocation. Only patients who would die would undergo LT, and those who would spontaneously recover would avoid unnecessary LT. Deriving and validating such a model for PALF, however, encompasses numerous challenges. In particular, the heterogeneity of age and etiology in PALF, as well as a lack of understanding of the natural history of the disease, contributed by the availability of LT has led to difficulties in prognostic model development. Several prognostic laboratory variables have been identified, and the incorporation of these variables into scoring systems has been attempted. A reliable targeted prognostic model for ALF in Wilson's disease has been established and externally validated. The roles of physiological, immunological, and metabolomic parameters in prognosis are being investigated. This review discusses the challenges with prognostic modeling in PALF and describes predictive methods that are currently available and in development for the future. Liver Transplantation 22 1418-1430 2016 AASLD.
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