LIVER-FAILURE IN CHILDREN WITH HEPATITIS-A

There have been very few reports dealing with liver failure related to hepatitis A in children. Moreover, the criteria usually used for sele cting patients with fulminant hepatitis A for liver transplantation ha ve not been evaluated in children, Therefore, the current study was co nducted retrospectively in a single French urban pediatric liver trans plantation center to serve as a reminder of the potential severity of hepatits A in children and to identify predictors of outcome, Children were selected by chart review using a data base system and were group ed according to outcome for analyses purposes. Over a 15-year period, 24 children with hepatitis A showed evidence of liver failure, includi ng 6 children who did not develop hepatic encephalopathy, 7 children i n whom encephalopathy occurred but resolved spontaneously, and 11 chil dren in whom death or liver transplantation was the outcome, The mean age at onset was 6.5 years. Those with the most rapid onset of liver f ailure from onset of jaundice had the best chance of recovery without developing encephalopathy. Otherwise, no predictive factors of outcome were found at onset of liver failure, Among the 18 children who devel oped encephalopathy, the best early prognostic indicator of a poor out come irrespective of the grade of encephalopathy, appeared to be a pro thrombin time level below 21% of normal combined with a serum bilirubi n level above 400 mu mol/L. Therefore, these two prognostic indicators may be helpful in deciding liver transplantation in children with hep atitis A-induced fulminant liver failure.