title: Paediatric acute liver failure and transplantation: the University of Essen experience.
abstract: To report our experience with 17 children who underwent a liver transplantation (LT) for acute liver failure (ALF). All LT procedures (deceased and living donor) were offered. Since 2003 Molecular Adsorbents Recycling System (MARS) was proposed as bridging procedure. We monitored the perioperative course and the short- and long-term outcomes. All children developed pretransplant hepatic encephalopathy (mostly grades II and III); six needed ventilator support and three haemodialysis. Median PELD/MELD score was 30. MARS was used in five children with poor pretransplant prognostic factors: all five survived the LT without sequelae. We performed 13 deceased donor LT (seven whole, five split and onr reduced) and four left lateral LDLT. Postoperative complications were observed in 10 children, requiring re-operation in seven. Two children developed irreversible neurological disorders. After a median follow up of 45 months, 16 children are still alive. About 1- and 5-year cumulative patient survival rates are 94% with a corresponding graft survival of 88% and 81%, respectively. The combination of experienced paediatric ICU management, the application of new liver support devices, and the capacity to offer both living and deceased donor transplant alternatives in a timely fashion represent the best formula to achieve optimal results in children with ALF.
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, University Hospital Essen, Essen, Germany. silvio.nadalin@uni-due.de
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Matthias
authors.initials: M
authors.lastname: Heuer
authors.forename: Michael
authors.initials: M
authors.lastname: Wallot
authors.forename: Marcus
authors.initials: M
authors.lastname: Auth
authors.forename: Randolph
authors.initials: R
authors.lastname: Schaffer
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Antje
authors.initials: A
authors.lastname: Ballauf
authors.forename: Maartje A J
authors.initials: MA
authors.lastname: van der Broek
authors.forename: Steven
authors.initials: S
authors.lastname: Olde-Damink
authors.forename: Peter F
authors.initials: PF
authors.lastname: Hoyer
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagò
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D017114:Liver Failure, Acute / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D016896:Treatment Outcome