Pediatric Acute Liver Failure: Current Perspectives

José Colleti Jr., Rafael Teixeira Azevedo and Werther Brunow de Carvalho

Pediatric Acute Liver Failure: Current Perspectives

It is well known that acute liver failure in children is rare but potentially
a life-threatening disorder. Its true incidence in the pediatric population is undetermined but is
responsible for 10-15% of all pediatric liver transplantations.

Unlike adults, a specific cause of pediatric ALF is not identified in almost half of the cases,
and the etiology is classified as indeterminate in 18-47% of all patients.
The etiology is important because the survival rate and
need for liver transplantation vary depending on the diagnosis.

Spontaneous recovery is better in children with toxic etiology and
worst for those with indeterminate or other causes.
There is no specific treatment for most ALF cases,
and the mainstay of medical care is to minimize
complications and to limit additional morbidity.

ALF can be associated with rapidly progressive multiorgan failure
and high mortality rates. One of the leading causes of death is
cerebral edema and intracranial hypertension,
responsible for about 20-25% of all deaths.

From that perspective, it is desirable to develop new therapies/technologies for
diagnostic investigation and interventions.

The use of transcranial Doppler is an important component in the assessment
of cerebral edema, which should be monitored. Some centers use invasive
intracranial pressure monitoring; however, non-invasive monitoring
of cerebral arterial flow is becoming a useful tool to identify ICH.

Two relevant articles4,5 tried to demonstrate the usefulness of TCD
to characterize the cerebral hemodynamics patterns in patients diagnosed with ALF.
TCD is becoming an important tool since there is no risk of complications like bleeding or infection,
which can occur in the use of invasive ICP monitoring.

They concluded that TCD could provide information about the dynamic
state of the intracranial circulation and perfusion with clinical complications

Liver Res Open J. 2017; 2(1): 14-15. doi: 10.17140/LROJ-2-111