934 Artificial Liver Support in Children with Fulminant Hepatic Failure: Our Experience

Abstract

Background: Fulminant hepatic failure (FHF) is characterized by the development of encephalopathy and impaired synthetic liver capacity in patients with previous normal liver function or well compensated liver disease. Orthotopic liver transplantation (OLTx) seems to be the only therapy proven to improve patient survival in most cases. The role of artificial liver support encompasses toxin removal and the reversal of the inflammatory process. Design: Retrospective analysis in children affected by FHF who underwent artificial liver support. Setting: Pediatric Intensive Care Unit in a Tertiary referral Hospital. Patients: 10 children with FHF were admitted to our PICU from January 1 2005 to December 31 2008. Results: Fifty per cent of patients were female and mean age was 57 months± 9,5. Most common cause of FHF was autoimmune (50%) followed by drugs and toxins induced (40%). The mean Pediatric End-Stage Liver Disease (PELD) score was 33± 9 and the electroencephalography recording showed severe signs of encephalopaty in all the patients. All patients but one underwent continuous veno-venous hemodiafiltration (CVVH). Delay from suspected diagnosis to the beginning of the depuration therapy ranged from few hours to 3 days. 5 patients underwent OLTx. All patients were dicharged with a good neurological status. Conclusions: The most important factor in predicting survival in FHF are the degree of encephalopathy, the patient's age, and the cause of FHF. Artificial support systems did not appear to affect the mortality rate and may “bridge” patients to OLTx or spontaneous recovery.