Acuteliverfailureinchildren英文书.pdf

Clinics and Research in Hepatology and Gastroenterology (2011) 35, 430—437 MINI REVIEW Acute liver failure in children Denis Devictor a,?, Pierre Tissieres a, Mickael Afanetti a, Dominique Debray b a Neonatal, Pediatric Intensive Care Unit, Department of Pediatrics, AP—HP, Bicêtre Hospital, Paris 11-Sud University, 78, avenue Général-Leclerc, 94275 Le Kremlin-Bicêtre, France b Pediatric Hepatology, AP—HP, Necker—Enfants-malades Hospital, 75015 Paris, France Available online 30 April 2011 Summary The management of children with acute liver failure mandates a multidisciplinary approach and intense monitoring. In recent years, considerable progress has been made in developing speci?c and supportive medical measures, but clinical studies have mainly concerned adult patients. There are no speci?c medical therapies, except for a few metabolic diseases presenting with acute liver failure. Liver transplantation still remains the only de?nitive therapy in most instances. Recent clinical studies suggest that hepatocyte transplantation may be useful for bridging patients to liver transplantation, for providing metabolic support during liver failure and for replacing liver transplantation in certain metabolic liver diseases. ? 2011 Published by Elsevier Masson SAS. Introduction Acute Liver Failure (ALF) is a rare but potentially devastating process that often leads to urgent liver transplantation when it is believed that liver regeneration is unlikely [1—3]. Its true incidence in the pediatric population is unknown but ALF accounts for 10 to 15% of all pediatric liver transplantations [1—3]. Exhaustive and up-to-date reviews have been published in the pediatric literature [4—10]. In neonates and infants, metabolic diseases are the main cause of ALF for which speci?c medical therapies may in some instances preclude the need for liver transplantation [1,9]. In older children, viruses (especially virus A), druginduced hepatotoxicity and autoimmune hepatitis are the ? Corresponding