title: Management of Pediatric Acute Liver Failure in a Region With Insufficient Deceased Donor Support: A Single-Center Experience.
abstract: OBJECTIVE
  Acute liver failure is a rapidly progressive and life-threatening disease in children, whose clinical features differ from those of adults.
  
  
  METHODS
  This is a review of a single center's experience with pediatric acute liver failure in a region with insufficient deceased donor support. The study is a retrospective review and analysis of 22 pediatric patients with acute liver failure between January 2007 and May 2013.
  
  
  RESULTS
  The cause of acute liver failure was indeterminate in 45.4% of cases. Listing for liver transplant was required in 72.7% of patients, whereas 27.3% developed spontaneous remission. In the patients placed on the liver transplant wait list, 75% underwent liver transplant and 25% died before undergoing liver transplant. The presence of ascites, high-grade encephalopathy, and laboratory findings including high lactate dehydrogenase and phosphorous levels and international normalized ratio were significant parameters in selecting patients needing liver transplants. All liver transplants were from living donors. One- and 3-year patient survival rates after liver transplant were 75% and 75%. No serious donor complications occurred.
  
  
  CONCLUSIONS
  Living-donor liver transplant may be the only option to save the lives of pediatric patients with acute liver failure, especially in regions with insufficient deceased-donor support. Timely referral to a multidisciplinary transplant center, expedient evaluation of living donors, and appropriate timing of transplant are crucial for a successful outcome.
authors.affiliation: From the Organ Transplantation Center, Memorial Sisli Hospital, Istanbul, Turkey.
authors.forename: Yucel
authors.initials: Y
authors.lastname: Yankol
authors.forename: Mustafa
authors.initials: M
authors.lastname: Ertugrul
authors.forename: Turan
authors.initials: T
authors.lastname: Kanmaz
authors.forename: Nesimi
authors.initials: N
authors.lastname: Mecit
authors.forename: Ilhan
authors.initials: I
authors.lastname: Ocak
authors.forename: Ozlem
authors.initials: O
authors.lastname: Durmaz
authors.forename: Koray
authors.initials: K
authors.lastname: Acarli
authors.forename: Munci
authors.initials: M
authors.lastname: Kalayoglu
mesh_terms: D000293:Adolescent; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014019:Tissue Donors / Q000600:supply & distribution*; D016896:Treatment Outcome; D014421:Turkey; D014850:Waiting Lists / Q000401:mortality