Mortality risk factors of a pediatric population with fulminant hepatic failure undergoing orthotopic liver transplantation in a pediatric intensive care unit*

Cost-effectiveness of childhood hepatitis A vaccination in Argentina: a second dose is warranted

“…Four immunization options were assessed: (1) no hepatitis A vaccination; (2) hepatitis A vaccination at age 12 months only; (3) hepatitis A vaccination at ages 12 and 72 months; and (4) hepatitis A vaccination at ages 12 and 18 months. As listed, these interventions are progressively more costly.…”

“…Assuming 20% of pediatric transplants and 5% of adult transplants are caused by hepatitis A (1), and comparing these numbers with hepatitis A cases occurring during the same period, the risk of liver transplant was estimated at 0.027% for cases ≤ 14 years, and 0.127% for cases >14 years. One-third of hepatitis A cases with acute liver failure were assumed to be unable to obtain a transplant (2,3). Age-specific case-fatality rates, derived from an expert panel review of published literature (5, 17), ranged from 0.14% for cases age ≤ 14 years to 0.36% for cases > 39 years.…”

Liver support for fulminant hepatic failure: Is it time to use the Molecular Adsorbents Recycling System in children?*

“…Endeavor in developing such systems remains essential. However, an even greater commitment should be given to improve epidemiologic control of viral hepatitis and vaccination and prevention of drug intoxication (73)(74)(75)(76)77 Rapid resolution of brain edema and improved cerebral perfusion pressure following the molecular adsorbent recycling system in…”

“…None has definitively proven its superiority. FHF severity in infants and children should be evaluated regarding the cause, progression of hepatic encephalopathy, and kinetics of liver failure (international normalized ratio, coagulation factor V activity, serum ammonia, and bilirubin levels) (8,73). Similarly to children with chronic liver disease awaiting for a liver transplantation, we have recently determined that the overall clinical condition of children with FHF could be accurately evaluated through the Pediatric Risk of Mortality score reflecting the extent of dysfunctioning organs or systems (hematologic, circulatory, renal, etc.)…”

Bridging to transplantation in acute liver failure in a 7-month-old infant

“…Encephalopathy occurs less often in children than in adults but carries a high risk of death or permanent neurological damage [1]. Mortality and morbidity after liver transplantation also result predominantly from hepatic encephalopathy [3]. In overt encephalopathy before transplantation, every hour of delay in detoxification may result in severe brain edema followed by permanent neurologic damage or death.…”