Hepatology 1992 Nov;16(5):1156-62

Emergency liver transplantation for fulminant liver failure in infants and children

Devictor D, Desplanques L, Debray D, Ozier Y, Dubousset AM, Valayer J, Houssin
D, Bernard O, Huault G
Unite de Reanimation Pediatrique, Hopital de Bicetre, Le Kremlin-Bicetre,
France.
Abstract
We report our results with orthotopic liver transplantation in children with
fulminant liver failure. Thirty-five children with fulminant liver failure were
evaluated for liver transplantation. The main causes of liver failure were viral
hepatitis (54.2%), drug-induced liver injury (14.2%) and Wilson's disease
(11.4%). Children were considered as candidates for liver transplantation only
if hepatic encephalopathy was associated with a decrease in the level of factor
V to below 25%. Seven children (20%) did not meet this criterion and recovered
spontaneously. Six children (17.1%) had contraindications for liver
transplantation and died. In three of these six children, contraindications
included irreversible brain damage at the time of admission. Twenty-two children
(62.8%) met the criteria for liver transplantation and were placed on the
emergency transplant list. Three of them died awaiting grafts. Nineteen children
underwent liver transplantation; 13 of them (68.4%) are alive without sequelae,
after 6 mo to 4 yr of follow-up, at this writing. Four of the children who died
after surgery had severe encephalopathy on admission that did not improve after
liver transplantation. In conclusion, emergency liver transplantation appears to
be an effective treatment for children with fulminant liver failure.
Nevertheless, irreversible brain damage developed in 10 patients, and they died
before or after surgery. We postulate that many of these deaths could have been
avoided if children had been transferred to a liver transplantation facility and
had undergone transplantation earlier. We emphasize that children with acute
liver failure should be transferred to a center that performs liver
transplantation before the development of hepatic encephalopathy