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[Fulminant hepatitis in children]
P Durand1, D Debray, D Devictor
1Service de Réanimation pédiatrique, Hôpital de Bicêtre, Le Kremlin-Bicêtre.
Insights
Fulminant hepatic failure in children, often caused by viral hepatitis, has a poor prognosis. Emergency liver transplantation significantly improves survival but faces challenges, driving innovation in liver support and graft strategies.
Area of Science:
- Pediatric Hepatology
- Transplantation Immunology
- Critical Care Medicine
Context:
- Fulminant hepatic failure (FHF) in children presents a critical medical challenge with high mortality rates.
- Viral hepatitis is a primary cause of FHF in pediatric populations, alongside metabolic disorders, toxins, and immune-related conditions.
- The prognosis for FHF without intervention is dire, with spontaneous recovery being unpredictable.
Purpose:
- To review the current management strategies for pediatric fulminant hepatic failure.
- To highlight the transformative role and persistent challenges of emergency orthotopic liver transplantation in pediatric FHF.
- To explore emerging and experimental therapeutic approaches for pediatric FHF.
Summary:
- Viral hepatitis is a leading cause of pediatric fulminant hepatic failure, a condition with an 80% mortality rate.
- Emergency orthotopic liver transplantation offers improved survival (55-80% at 1 year) but faces hurdles in patient selection, organ availability, and preoperative care.
- Innovations include graft splitting, auxiliary liver grafts, xenografts, and bioartificial liver support systems, with preventive strategies being crucial.
Impact:
- Emergency liver transplantation has revolutionized pediatric FHF management, offering a life-saving option.
- Ongoing research into novel surgical techniques and artificial liver support aims to overcome graft shortages and improve outcomes.
- Preventive measures remain a cornerstone in combating the incidence and impact of fulminant hepatitis in children.
Abstract:
Viral hepatitis are one of the main causes of fulminant hepatic failure in children. Other causes of fulminant hepatic failure include metabolic diseases, especially in neonates and in infants, toxin-or drug-induced liver injury, hematologic and immune diseases. The spontaneous prognosis of fulminant hepatitis is poor with an overall mortality reaching 80%. The management of children with fulminant hepatic failure has been significantly transformed by emergency orthotopic liver transplantation. With this procedure, 1-year survival rates range from 55 to 80%. However, emergency liver transplantation still encounters serious problems including patient selection, organ availability, and the definition of optimum preoperative management of these patients. Several surgical innovations have been developed to resolve the shortage in liver grafts such as liver graft reduction or splitting for transplantation in two recipients. Because, spontaneous recovery remains unpredictable, new techniques are proposed such as the temporary orthotopic transplantation of auxiliary liver grafts, xenografts with monkey or pigs livers, hepatic assistance and bioartificial livers. These evolving strategies are currently under evaluation. Preventive treatment is one of the most effective approaches to fulminant hepatitis.