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[Treatment of acute liver failure in children]
1Service d'hépatologie pédiatrique, hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
Insights
Acute liver failure (ALF) in children stems from metabolic diseases, viral infections, or toxins. Prompt diagnosis and management, including potential liver transplantation, are crucial for survival.
Area of Science:
- Pediatric Hepatology
- Pediatric Critical Care
- Transplant Surgery
Context:
- Acute liver failure (ALF) in children presents significant management challenges.
- Etiologies include metabolic diseases, viral hepatitis, and toxin/drug-induced liver injury.
- Approximately 30% of pediatric ALF cases have an undetermined cause.
Purpose:
- To outline the critical management steps for pediatric acute liver failure.
- To emphasize the importance of urgent etiological diagnosis and timely intervention.
- To define the role of specialized pediatric hepatology and transplant teams.
Summary:
- Management requires a multidisciplinary approach in specialized units for diagnosis, treatment, and transplantation evaluation.
- Key steps include urgent etiological diagnosis, specific and symptomatic therapies, and prognostic assessment.
- Liver transplantation is a critical option for selected pediatric ALF patients.
Impact:
- Establishes a framework for optimizing care in pediatric acute liver failure.
- Highlights the necessity of early intervention and specialized care for improved outcomes.
- Provides survival statistics for liver transplantation in pediatric ALF, averaging 65%.
Abstract:
Among the main causes of acute liver failure (ALF) in children, metabolic diseases (especially in infants), viral and toxin or drug induced hepatitis are the most frequent. The cause remains, however, undetermined in about 30% of the cases. Management must be conducted in a pediatric hepatology unit or intensive care unit in relation with a pediatric transplant team in order: 1) to perform urgent etiological diagnosis; 2) to initiate specific therapy and symptomatic treatment; 3) to evaluate the severity and prognosis of liver disease for selection of children for emergency liver transplantation; 4) to evaluate contraindications to liver transplantation. The overall survival of post-emergency liver transplantation for ALF in children averages 65%.