TRANSPLANTATION FOR ACUTE HEPATIC-FAILURE IN CHILDREN

Background/Purpose: Acute liver failure in the pediatric population is a rare but highly lethal health problem. Sometimes it is difficult to predict who will benefit from liver transplantation. The authors repo rt on their experience in the past 8 years at a pediatric transplant c enter. Methods: A retrospective chart review was performed on all chil dren referred to the liver transplant (TX) service with the diagnosis of acute hepatocellular dysfunction (AHD) from 1988 to 1996. Presentat ion, chemistries, and clinical course were evaluated. Statistical anal ysis was performed using analysis of variance. Results: Twenty-six chi ldren underwent evaluation. Seventeen patients fulfilled the criteria for fulminant hepatic failure (FHF). Eleven patients recovered without TX, 14 received a TX, and one died awaiting TX. Of those that receive d a TX, four died in the early postoperative period and 10 survived (m ean follow-up of 4.2 years). There was a wide range in most laboratory values. Serum bilirubin levels, ammonia levels, and coagulation param eters, however, reached statistical significance in patients requiring transplant. The most consistent discriminators of need for transplant ation and outcome were neurological findings and multisystem organ fai lure. Children who recovered without TX had no seizures and minimal en cephalopathy. Of the 15 children who were recommended for TX, six had seizures and all had encephalopathy, 12 having grade III or IV. All fi ve nonsurvivors had respiratory failure early in their clinical course , and four of five nonsurvivors also had renal failure. Conclusions: T here is significant overlap in the presentation and laboratory finding s of children who present with AHD or FHF. Neurological status was an important discriminator of need for transplantation. Patients who pres ented with multisystem organ failure, including renal failure and resp iratory failure, had 100% mortality rate despite liver transplantation . J Pediatr Surg 33:998-1003. Copyright (C) 1998 by W.B. Saunders Comp any.