Acute liver failure in children

Abstract

Acute liver failure (ALF) in children is a multi-systemic life distress. It is characterized by a rapid deterioration of liver function associated with a coagulopathy (PT <50% with encephalopathy or PT <30% without encephalopathy) not corrected by vitamin K. Etiology of ALF varies with age at onset. ALF in the newborn is mainly caused by gestational alloimmune liver disease, herpes infection or inherited metabolic disorder. In infants, hereditary metabolic diseases and infections are at the forefront, ahead of autoimmune, malignant or vascular causes. In children over 2 years old, etiology is similar to what is observed in adults. Approximately 30% of ALF in children remain indeterminate, with poorer prognosis. A rigorous etiological investigation is crucial in order to quickly implement appropriate treatment and evaluate indication to liver transplantation. Management of these patients must be done in cooperation with expert centers.