Objective To evaluate the
efficacy of
liver transplantation for
acute liver failure (ALF) in
children.
Methods Clinical data of 15
children with ALF
who underwent
liver transplantation were collected and retrospectively analyzed. The proportion of ALF among
children undergoing
liver transplantation during the same period was calculated. The characteristics,
postoperative complications and clinical
prognosis of ALF
children receiving
liver transplantation were analyzed. Results In the same period, the proportion of ALF was 2.0% (15/743) among pediatric recipients undergoing
liver transplantation. All 15
children had acute onset of ALF, and most of them were accompanied by
fever,
diarrhea and progressive yellowing of
skin and
sclera. Thirteen
children were complicated with
hepatic encephalopathy before operation (6 cases of stage Ⅳ
hepatic encephalopathy), and two
children were complicated with myelosuppression and
granulocytopenia before
liver transplantation. Ten
children underwent
living donor liver transplantation with relative
donor liver, 4 received
liver transplantation from donation after
cardiac death (DCD), and 1 underwent Domino
donor-auxiliary
liver transplantation. Of 15
children, 12 recipients had the same
blood type with their
donors, 1 recipient had compatible
blood type with the
donor and 2 cases had different
blood type with their
donors. Among 15
children, 10 cases developed
postoperative complications. Postoperative
cerebral edema occurred in 5 cases, of whom 4 cases died of diffuse
cerebral edema, and the remaining case was in a
persistent vegetative state (
eyes-open
coma). Postoperative
cytomegalovirus (CMV)
infection was seen in 5 cases. Two
children presented with
aplastic anemia and survived after
bone marrow transplantation, 1 case died of CMV
hepatitis and
viral encephalitis, and 2 cases died of diffuse
brain edema. One
child developed
graft-versus-host disease (GVHD) after
liver transplantation, and died of
septic shock after
bone marrow transplantation. Nine
children survived and obtained favorable
liver function during postoperative follow-up. Conclusions
Liver transplantation is an efficacious
treatment for ALF in
children, which may enhance the
survival rate.
Brain edema is the main
cause of death in ALF
children following
liver transplantation, and
treatment such as lowering
intracranial pressure, improving
brain metabolism and
blood purification should be actively performed.
Liver transplantation should be promptly performed prior to the
incidence of irreversible neurological damage in ALF
children, which might prolong the
survival and enhance long-term
prognosis.