Acute liver failure and transplantation in children

Horslen, Simon

doi:10.7196/samj.8615

Cited by 5 publications

(2 citation statements)

References 24 publications

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“…While we defer to the KCC in our clinical practice, it is noteworthy that our high MELD or PELD scores also corroborated the need for liver transplantation. Although scoring systems may assist with decision making, our final judgment depends on the dynamic assessment of the child's disease progression and not on a single set of laboratory measurements 22 …”

Section: Discussionmentioning

confidence: 99%

Minding the gap—Providing quality transplant care for South African children with acute liver failure

Bruckmann

Beretta

Demopolous

et al. 2020

Pediatric Transplantation

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Pediatric ALF is rare but life-threatening and may require urgent transplantation. In low and middle-income countries, access to transplantation is limited, deceased organ donation rates are low, and data on outcomes scarce. The Wits Donald Gordon Medical Centre, in Johannesburg, is one of only two centers in South Africa that perform pediatric liver transplant. We describe the etiology, clinical presentation, and outcomes of children undergoing liver transplant for ALF at our center over the past 14 years. We performed a retrospective chart review of all children undergoing liver transplantation for ALF from November 2005 to September 2019. Recipient data included demographics, clinical and biochemical characteristics pretransplant, post-operative complications, and survival. We conducted descriptive data analysis and used the Kaplan-Meier method for survival analysis. We performed 182 primary pediatric liver transplants. Of these, 27 (15%) were for ALF, mostly from acute hepatitis A infection (11/27;41%). Just over half of the grafts were from living donors (15/27;56%), and five grafts (5/27;19%) were ABO-incompatible. The most frequent post-transplant complications were biliary leaks (9/27;33%). There were two cases of hepatic artery thrombosis (2/27;7%), one of whom required re-transplantation. Unadjusted patient and graft survival at one and 3 years were the same, at 81% (95% CI 61%-92%) and 78% (95% CI 57%-89%), respectively. At WDGMC, our outcomes for children who undergo liver transplantation for ALF are excellent. We found workable solutions that effectively addressed our pervasive organ shortages without compromising patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Minding the gap—Providing quality transplant care for South African children with acute liver failure

Bruckmann

Beretta

Demopolous

et al. 2020

Pediatric Transplantation

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“…Existing scoring systems, such as the Kings College Hospital Criteria (KCHC), pediatric- end stage liver disease (PELD), model for end stage liver disease (MELD) and the Clichy scoring system are currently used in pediatric hepatology and transplant units [ 14 ]. None of these scoring systems have proved to be reliable predictors of survival with their native liver in PALF patients.…”

Section: Introductionmentioning

confidence: 99%

Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure

et al. 2022

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Background Pediatric acute liver failure (PALF) is an uncommon, devastating illness with significant mortality. Liver transplantation remains the mainstay of treatment for irreversible PALF. The purpose of this study was to determine the etiology and prognostic factors associated with outcome of PALF in South Africa and to evaluate prognostic scoring systems used. Methods Records of 45 pediatric patients younger than 16 years of age who presented with PALF from 1 January 2015 till 31 October 2020 were analysed. Patients were divided into two groups with one group consisting of patients with spontaneous recovery of the liver with supportive treatment (6/45:13.3%) and the second group consisting of patients with poor outcomes who demised (19/45: 42%) or underwent liver transplantation (20/45: 44%). Results The median age of presentation was 3.3 years (IQR 1.8–6.9) with the 1–5 years age group constituting majority of patients (55.6%). Median time to follow up was 6.1 months (IQR 0.2–28.8). Higher liver injury unit scores were observed in patients who had poorer outcomes (P = 0.008) with a threshold of greater than 246 having a sensitivity of 84% and specificity of 83% (P < 0.001). Higher peak PELD/MELD (P = 0.006) and admission UKELD (P = 0.002) scores, were found in patients with poorer outcomes. Kings College Hospital criteria (KCHC) was useful in predicting which patients would die without liver transplantation (P = 0.002). Liver transplantation was performed in 20/45 (44%) patients with a post transplantation 1 year patient and graft survival of 80%. Conclusion Although, survival of PALF patients was lower than high and other low-middle income countries, outcomes post transplantation were good. Our study demonstrates the utility of dynamic scoring systems in PALF patients, it underscores the need for early referral and clinical monitoring in a tertiary center once the criteria for PALF have been met.

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Maintenance of the Infant or Child with End Organ Failure

Malatack¹

2018

Solid Organ Transplantation in Infants and Children

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Acute liver failure and transplantation in children

Cited by 5 publications

References 24 publications

Minding the gap—Providing quality transplant care for South African children with acute liver failure

Minding the gap—Providing quality transplant care for South African children with acute liver failure

Prognostic factors and scoring systems associated with outcome in pediatric acute liver failure

Maintenance of the Infant or Child with End Organ Failure

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