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 23 May 2018

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News

Prognostic indicators of childhood fulminant hepatic failure

This month's Journal of Pediatric Gastroenterology and Nutrition reports that children with fulminant hepatic failure with severe coagulopathy and lower alanine aminotransferase on admission are more likely to require liver transplantation.

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Dr Lee and colleagues studied the etiology, outcome and prognostic indicators in children with fulminant hepatic failure in the United Kingdom.

The researchers conducted a retrospective review of all patients less than 17 years old with fulminant hepatic failure from 1991 to 2000.

The team defined fulminant hepatic failure as the presence of coagulopathy by prothrombin time more than 24 seconds or International Normalized Ratio more than 2.0.

Fulminant hepatic failure was also defined as with or without hepatic encephalopathy within 8 weeks of the onset of symptoms.

The research team conducted the study at the liver Unit, Birmingham Children's Hospital in England.

Transplantation is more likely with prolonged duration of illness before onset of hepatic encephalopathy
Journal of Pediatric Gastroenterology and Nutrition

The team identified 97 children with fulminant hepatic failure, of which 48 were male and 49 were female with a median age of 27 months.

The researchers noted that there were 22 metabolic, 53 infectious, 19 drug-induced, and 3 autoimmune hepatitis etiologies.

The team found that the overall survival rate was 61% and that 33% recovered spontaneously with supportive management.

The investigators assessed 55 children for liver transplantation of which 4 were unstable and were not listed for liver transplantation.

The researchers reported that 11 patients died while awaiting liver transplantation.

Liver transplantation was contraindicated in 10 children and of the 40 children who underwent liver transplantation, 27 survived.

The team observed that children with autoimmune hepatitis, paracetamol overdose or hepatitis A were more likely to survive without liver transplantation.

The research team also noted that children who had a delay between the first symptom of liver disease and the onset of hepatic encephalopathy were more likely to die of fulminant hepatic failure.

The team reported that children with higher plasma bilirubin, higher prothrombin time or lower alanine aminotransferase levels on admission were also more likely to die of fulminant hepatic failure or require liver transplantation.

In addition, the researchers found that the significant independent predictors for the eventual failure of conservative therapy included time to onset of hepatic encephalopathy more than 7 days.

Other independent predictors for the eventual failure of conservative therapy were prothrombin time of more than 55 seconds and alanine aminotransferase less than or equal to 2384 IU/L on admission.

Dr Lee’s team concluded, “Children with fulminant hepatic failure with severe coagulopathy, lower alanine aminotransferase on admission and prolonged duration of illness before the onset of hepatic encephalopathy are more likely to require liver transplantation.”

“Early referral to a specialized center for consideration of liver transplantation is vital”.

J Pediatr Gastroenterol Nutr 2005: 40(5): 575-581
10 May 2005

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