OUTCOME OF CHILDREN WITH CEREBRAL EDEMA CAUSED BY FULMINANT HEPATIC-FAILURE

Mortality is high in patients with fulminant hepatic failure (FHF). Ne urologic complications of encephalopathy and cerebral edema are major contributors to mortality, Orthotopic liver transplantation has improv ed survival in these patients, However, the complexity of medical and surgical problems in this patient population, coupled with a severe sh ortage of organs, requires careful patient selection. The aim of this study was to describe the neurologic outcome of children with FHF who developed radiologically apparent cerebral edema. The hospital and out patient records and radiologic studies of 20 children with FHF admitte d to Children's Hospital of Pittsburgh from 1981-1995 who developed en cephalopathy and computed tomographic evidence of cerebral edema were reviewed. Fourteen patients died (70%), three were left with severe ne urologic deficits (15%), and three were left with moderate deficits (1 5%), Survival was correlated,vith a lesser degree of coma. Histopathol ogic examination of eight brains demonstrated cerebral edema and wides pread ischemic neuronal necrosis in all eight. The presence of radiogr aphic cerebral edema in children with FHF is an objective measure that indicates a very poor prognosis. Termination of care is a reasonable option Comprehensive monitoring of cerebral function and intracranial pressure is required in children with FHF, Orthotopic liver transplant ation should be performed in children with severe and worsening enceph alopathy before the development of radiographically apparent cerebral edema. (C) 1998 by Elsevier Science Inc. All rights reserved.