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Acute liver failure in children: Etiology and evaluation

Robert H Squires, Jr, MD, FAAP
Section Editor
Elizabeth B Rand, MD
Deputy Editor
Alison G Hoppin, MD


Pediatric acute liver failure (PALF) is a complex, rapidly progressive clinical syndrome that is the final common pathway for many disparate conditions, some known and others yet to be identified [1-3]. The estimated frequency of acute liver failure (ALF) in all age groups in the United States is about 17 cases per 100,000 population per year, but the frequency in children is unknown. PALF accounts for 10 to 15 percent of pediatric liver transplants performed in the United States annually.

PALF is a rapidly evolving clinical condition. There are no adequately powered studies to inform diagnostic algorithms, to assess markers of disease severity and trajectory, or to guide decisions about liver transplantation (LT). The clinician must construct an individualized diagnostic approach and management strategy. Management requires a multidisciplinary team involving the hepatologist, critical care specialist, and liver transplant surgeon.

The pressing clinical questions faced when children with PALF first present are:

Does the patient have a condition that is treatable?

What is the risk of deterioration or improvement on each day the child is alive with his or her native liver?

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Literature review current through: Dec 2017. | This topic last updated: Jun 20, 2017.
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