Early Hybrid Extracorporeal Therapies in Pediatric Acute Liver Failure of Unknown Etiology

Abstract

We describe a 9-year-old boy with acute liver failure of unknown etiology, unresponsive to standard medical therapy, with increasing hyperammonemia blood level, lactate elevation, a pediatric end liver stage of 20, a hepatic encephalopathy (HE) score of 2, and scheduled for emergent liver transplantation on the waiting list. We admitted him in the pediatric intensive care unit and managed him in the early stages with continuous renal replacement therapy and therapeutic plasma exchange as soon as neurologic impairment started to worsen. He recovered from his HE after 3 days of blood purification and was removed from the transplantation waiting list due to progressive liver function improvement.This case report comply with the guidelines for human studies and the research was conducted ethically in accordance with the World Medical Association Declaration of Helsinki. In the manuscript, parents or guardians have given their written informed consent to publish their case (including publication of images). The study protocol was approved by the institute's committee on human research.