Bridging to transplantation in acute liver failure in a 7-month-old infant.
BACKGROUND
Acute liver failure (ALF) in children is a rare but often fatal event. At present, liver transplantation is the only successful therapy in most cases. In the face of deteriorating hepatic encephalopathy in these children, some bridging therapy using artificial detoxification can be necessary to enable successful transplantation. In adults, albumin dialysis using the molecular absorbent recycling system (MARS) has been described as effective for bridging to liver transplantation.


METHODS
A previously healthy 7-month-old infant was admitted with ALF due to autoimmune hepatitis. King's College criteria for children with ALF indicated the need for transplantation (bilirubin 13.7 mg/dl, leukocytes 18,980/mm3, INR 5.83, age<2 years). Despite moderate hyperammonemia (75 microm/l) along with the development of pneumonia, the child deteriorated hemodynamically and neurologically, showing grade III encephalopathy proven by EEG. Albumin dialysis using MARS was used to bridge 36 hours to successful living-donor split-liver transplantation, and resulted in improvements in EEG, plasma levels of amino acids and hemodynamics. Twenty-four months after transplantation the child shows normal liver function and normal neuropsychological development. The explanted liver showed 80 % tissue destruction from autoimmune hepatitis.


CONCLUSIONS
Albumin dialysis as described can be used successfully in infants < 1 year old for bridging to liver transplantation in cases of acute hepatic failure with deteriorating encephalopathy.
Trittenwein
Gerhard
G
PICU, University of Vienna, and Department of Clinical Pathology, University Children's Hospital, University of Vienna, Austria. gerhard.trittenwein@meduniwien.ac.at
Boigner
Harald
H
Mostafa
Gehan
G
Burda
Gudrun
G
Mühl
Adolf
A
Amann
Gabriele
G
Pollak
Arnold
A
D000418:Albumins / Q000008:administration & dosage*; D006501:Hepatic Encephalopathy / Q000209:etiology* / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D017114:Liver Failure, Acute / Q000150:complications* / Q000628:therapy*; D016031:Liver Transplantation; D008297:Male; D011300:Preoperative Care / Q000379:methods; D006435:Renal Dialysis / Q000379:methods*; D016896:Treatment Outcome
D000418:Albumins