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Chapter 4 - Acute liver failure in children

from Section I - Pathophysiology of pediatric liver disease

Published online by Cambridge University Press:  05 March 2014

By
Robert H. Squires  and
Estella M. Alonso
Edited by
Frederick J. Suchy ,
Ronald J. Sokol  and
William F. Balistreri
Robert H. Squires
Affiliation:
Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh of UPMC, and Professor of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA
Estella M. Alonso
Affiliation:
Northwestern University, Chicago; Department of Gastroenterology, Hepatology and Nutrition, Children’s Memorial Hospital, Chicago, IL, USA
Frederick J. Suchy
Affiliation:
University of Colorado Medical Center
Ronald J. Sokol
Affiliation:
University of Colorado Medical Center
William F. Balistreri
Affiliation:
University of Cincinnati College of Medicine
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Summary

Introduction

Pediatric acute liver failure (ALF) is not a single diagnosis. Rather, pediatric ALF is a complex, rapidly progressive clinical syndrome that is the final common pathway for many disparate conditions; some known and others yet to be identified [1,2]. The estimated frequency of ALF in all age groups in the USA is about 17 cases per 100000 population per year, but the frequency in children is unknown. In the USA, ALF accounts for 10–15% of pediatric liver transplants performed annually. Management requires a multidisciplinary team involving the hepatologist, critical care specialist, and liver transplant surgeon.

Acute liver failure is a rapidly evolving clinical condition. The absence of adequately powered studies to inform diagnostic algorithms, to assess markers of disease severity and trajectory, and to guide liver transplant decisions transfers a significant burden to the clinician. Constructing a diagnostic approach and individualized management strategy that may include the decision to pursue liver transplantation is challenging. There are a number of pressing clinical questions faced when children with pediatric ALF first present. Does the patient have a condition that is treatable? What is the risk of deterioration or improvement on each day the child is alive with his/her native liver? Is a living related or deceased liver transplant necessary for patient survival? Is full recovery possible without a liver transplant? Are associated morbidities recoverable or irreversible?

Type
Chapter
Information
Liver Disease in Children , pp. 32 - 50
Publisher: Cambridge University Press
Print publication year: 2014

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  • Acute liver failure in children
    • By Robert H. Squires, Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh of UPMC, and Professor of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA, Estella M. Alonso, Northwestern University, Chicago; Department of Gastroenterology, Hepatology and Nutrition, Children’s Memorial Hospital, Chicago, IL, USA
  • Edited by Frederick J. Suchy, University of Colorado Medical Center, Ronald J. Sokol, University of Colorado Medical Center, William F. Balistreri
  • Book: Liver Disease in Children
  • Online publication: 05 March 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139012102.005
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To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

  • Acute liver failure in children
    • By Robert H. Squires, Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh of UPMC, and Professor of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA, Estella M. Alonso, Northwestern University, Chicago; Department of Gastroenterology, Hepatology and Nutrition, Children’s Memorial Hospital, Chicago, IL, USA
  • Edited by Frederick J. Suchy, University of Colorado Medical Center, Ronald J. Sokol, University of Colorado Medical Center, William F. Balistreri
  • Book: Liver Disease in Children
  • Online publication: 05 March 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139012102.005
Available formats
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Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Acute liver failure in children
    • By Robert H. Squires, Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Hospital of Pittsburgh of UPMC, and Professor of Pediatrics, University of Pittsburgh, Pittsburgh, PA, USA, Estella M. Alonso, Northwestern University, Chicago; Department of Gastroenterology, Hepatology and Nutrition, Children’s Memorial Hospital, Chicago, IL, USA
  • Edited by Frederick J. Suchy, University of Colorado Medical Center, Ronald J. Sokol, University of Colorado Medical Center, William F. Balistreri
  • Book: Liver Disease in Children
  • Online publication: 05 March 2014
  • Chapter DOI: https://doi.org/10.1017/CBO9781139012102.005
Available formats
×