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• W2053224037 abstract "A228 Aims: Liver transplantation has been recognized as an effective therapeutic procedure for end-stage liver disease. Fulminant hepatic failure is also an indication for liver transplantation. Using appropriate support, i.e., continuous hemodiafiltration (CHDF) and plasma exchange, liver function could recover. However, not a few patients develop cerebral edema or multi-organ failure before completion of liver regeneration. Furthermore, in pediatric cases, causes of hepatic failure are unknown in many cases. Therefore, we should be always careful to make a therapeutic decision in these setting. AIM of this paper is to verify the validity of the guidelines which are defined by Japan acute liver failure study group from the viewpoints of an indication and optimal timing of living donor liver transplantation for children. Methods: We have treated 10 children suffering from sever liver dysfunction from 1999. 10. to 2003.12. (3 months to 14 years old). Living donor liver transplantation (LDLT) was performed in 7 patients. Five of them are alive in 13 months to 52 months (mean: 30.6 months) after transplantation. Two patients out of 7 were lost at 10 and 4 months after operation respectively. In 3 patients out of 10 patients, we did not perform LDLT. Because one patient was recovered spontaneously by CHDF and plasma exchange therapy, the other two patients was diagnosed to Reye like syndrome and hemophagocytic syndrome respectively which indicated contra-indication of LDLT. Results: We evaluated 10 patients according to the guidelines which are defined by Japan acute liver failure study group in 1996. Five patients fulfilled the criteria (one patient: no need of liver transplantation, 4 patients: need for liver transplantation). In this group, 4 patients were performed LDLT, all the five patients were alive. On the other hand, the criteria were not fulfilled in 5 patients. All the five patients developed severe encephalopathy in day 2 or 3. Two patients were diagnosed immediately as systemic disease which were not indicated as liver transplantation therapy and died at day 4 and day 21 respectively. The other 3 patients were performed LDLT within 5 days after admission. However, only one patient survived after LDLT. Another patient developed severe cerebral edema immediately after LDLT. The other one patient was lost at 4 months after LDLT by chronic rejection. Conclusions: 1. The survival rate of the patients with fulminant hepatic failure who could keep the guideline would be very high (100% in our series). 2. Patients with fulminant hepatic failure should be considered LDLT as soon as possible when hepatic encephalopathy develops. 3. However, the systemic disease which shows hepatic failure should be neglected immediately to evaluate the contra-indication of LDLT. 4. Construction of highly sophisticated ‘pediatric liver team’ should be needed." @default.
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• W2053224037 date "2004-07-01" @default.
• W2053224037 modified "2023-09-24" @default.
• W2053224037 title "AN INDICATION AND OPTIMAL TIMING OF LIVING DONOR LIVER TRANSPLANTATION FOR FULMINANT HEPATIC FAILURE IN CHILDREN" @default.
• W2053224037 doi "https://doi.org/10.1097/00007890-200407271-01955" @default.
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