Acute Liver Failure in Children

Acute liver failure (ALF), or fulminant liver failure, is a rare disorder in children that causes the liver to stop working normally, usually because the cells in the liver die or are damaged over a short period of time. It is vital that children with ALF receive immediate care.

Symptoms of ALF vary among children but may include jaundice, bleeding and a change in alertness or even a coma.

• Babies more than one-month-old may be irritable and inconsolable
• Children may be drowsy, confused and forgetful
• Older kids may appear to be angry and extremely tired during the day

In children, encephalopathy may be subtle or a very late finding. Liver encephalopathy is the deterioration of brain function and damage to the nervous system due to toxic substances building up in the blood, which are normally removed by the liver.

ALF may be caused by a number of conditions: infections such as hepatitis, herpes and others; drugs and toxins like acetaminophen (Tylenol); cardiovascular problems; metabolic disorders such as Wilson disease and fatty acid oxidation defects; and autoimmune hepatitis. Sometimes, the cause of ALF may not be known (idiopathic).

Children with ALF need comprehensive follow-up in the setting of a pediatric intensive care unit. They need frequent monitoring of their vital signs, neurological status and comprehensive blood work to determine the cause of liver failure and monitor whether the liver is headed for recovery or failure.

Treatments for acute liver failure

The treatments for ALF vary widely and heavily depend on its cause.

Supportive Care: The liver has the potential of regenerating itself. In ALF there is a balance between cell destruction and growth. The liver function can be supported by blood products, dialysis and plasma exchange for short periods of times. To date, there is no artificial liver and if the liver does not show signs of regeneration, a liver transplant is the only option for survival.

Medication: Some causes of ALF may be treated medically, such as autoimmune hepatitis, acetaminophen (Tylenol) toxicity, certain viral hepatitis and metabolic diseases.

Liver Transplant: About half of the children with ALF, and a larger percent with ALF with no known cause, will need a liver transplant. 

The survival rate for children with acute liver failure who have a liver transplant is as high as 90 percent. While the outcome for liver transplantation is generally good, there is a higher risk of having blood and bone marrow complications following liver transplant in a patient with acute liver failure. Neurological recovery (mental status) depends on the level of brain damage at the time of transplant. The less damage suffered prior to transplant, the better the chance for recovery.

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