Optimizing the diagnosis and treatment of acute liver failure in pediatrics

Pediatric acute liver failure (p-ALF) is a rare disorder wich results in death or the need for liver transplantation (LT) in 25-40% of cases. Distinghishing the children with p-ALF who require LT from those patients who will likely survive with intensive medical care alone remains a unclear making a challenge the decision of when to transplant a patient. The scoring systems availables for prognosis evaluation in adults are unable to predict survival without LT of pediatric patients. In our hospital we use the indocyanine green plasma disappearance rate as a tool to predict the evolution of pediatric patients with acute liver failure. Following our experience, a cutoff value of ICG-PDR of 5.9%/min has 91.6% sensitivity and 96.8% specificity for assessing the need for liver transplantation, improving the categorization of patients with pediatric acute liver failure In the setting of actue liver failure, extracorporeal liver assist devices like MARS (Molecular Adsorbent Recirculating System) may buy time for native liver recovery or serve as bridging therapy to liver transplantation, with reduced risk of cerebral complications. MARS treatment may alleviate hepatic encephalopathy even in patients with a completely necrotic liver.