Demographics, aetiology and outcome of paediatric acute liver failure in Singapore

Introduction: The aetiology of paediatric acute liver failure (PALF) varies widely according to age, and geographic and socioeconomic factors. This study aimed to examine the epidemiology, aetiology and outcome of PALF in Singapore at a single centre. Methods: A retrospective review was performed of patients aged 0–18 years who were diagnosed with PALF from 2007 to 2019. PALF was defined by: absence of chronic liver disease; biochemical evidence of acute liver injury; and coagulopathy, non-correctible by vitamin K, defined as prothrombin time (PT) ≥ 20 seconds or international normalised ratio (INR) ≥ 2.0 regardless of hepatic encephalopathy (HE) or PT ≥ 15 seconds or INR ≥ 1.5 in the presence of HE. Results: 34 patients were included. Median age at diagnosis was 10 months (range 7 days to 156 months). The top three causes of PALF were indeterminate (41.2%), metabolic (26.5%) and infectious (26.5%) aetiologies. A metabolic disorder was the most frequent aetiology in infants < 12 months (38.9%), whereas an indeterminate cause was the most common in children > 12 months (50%). No cases of viral hepatitis A or B presenting with PALF were detected. Overall spontaneous recovery rate (survival without liver transplantation [LT]) was 38.2%, and overall mortality rate was 47.1%. Six patients underwent living-donor LT, and the post-transplant survival at one year was 83.3%. Conclusion: The aetiologic spectrum of PALF in Singapore is similar to that in developed Western countries, with indeterminate aetiology accounting for the majority. PALF is associated with poor overall survival; hence, timely LT for suitable candidates is critical to improve survival outcomes.

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Acute Liver Failure Requiring Liver Transplantation due to Acute Hepatitis A Virus Infection

Case Reports in Transplantation ◽

10.1155/2021/5159934 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Chencheng Xie ◽

Jonathan M. Fenkel ◽

Dina L. Halegoua-DeMarzio ◽

Jesse M. Civan ◽

Danielle M. Tholey ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Hepatitis ◽

Hepatitis A ◽

Hepatitis A Virus ◽

University Hospital ◽

Close Monitoring ◽

King’S College Criteria ◽

One Year

Introduction. Hepatitis A infection (HAV) is generally characterized by an acute icteric illness or may have a subclinical self-limited course, although rarely, can result in fulminant hepatitis and death. In 2019, the City of Philadelphia declared a public health emergency due to an HAV outbreak. We are reporting a series of four cases of acute liver failure (ALF) requiring liver transplantation (LT) due to acute HAV. Methods. Chart review and case descriptions of four patients with acute HAV-related ALF who were expeditiously evaluated, listed as Status 1A, and who underwent LT between August 2019 and October 2019 at Thomas Jefferson University Hospital. Results. All four patients presented with acute hepatocellular jaundice and had a positive HAV IgM, and all other causes of ALF were excluded. All four cases met the American Association for the Study of Liver Diseases (AASLD) criteria for ALF. Three of the four cases met King’s College Criteria of poor prognosis for nonacetaminophen-induced ALF. All four patients underwent successful LT and were discharged six to twelve days postoperatively. One patient died of disseminated Aspergillus infection five months after LT, while the others have had excellent clinical outcomes shown by one-year follow-ups. All four explants had remarkably similar histological changes, revealing acute hepatitis with massive necrosis accompanied by a prominent lymphoplasmacytic inflammatory infiltrate and bile ductular proliferation. Conclusion. Although rare, patients presenting with acute HAV need close monitoring as they may rapidly progress to ALF. Early referral to a transplant center afforded timely access to LT and yielded overall good one-year survival. Widespread HAV vaccination for high-risk individuals is an essential strategy for preventing disease and curbing such future outbreaks.

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Acute liver failure complicating viral hepatitis A

The Brazilian Journal of Infectious Diseases ◽

10.1590/s1413-86702004000200009 ◽

2004 ◽

Vol 8 (2) ◽

Cited By ~ 1

Author(s):

Daniel Rui Diniz-Santos ◽

Maria Clotildes Nunes de Melo ◽

Rita Franca Melo ◽

Luciana Rodrigues Silva

Keyword(s):

Liver Failure ◽

Acute Liver Failure ◽

Viral Hepatitis ◽

Hepatitis A ◽

Viral Hepatitis A

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Tc-99m GSA scintigraphy within the first 3 days after admission as an early predictor of outcome in severe acute liver injury

Scientific Reports ◽

10.1038/s41598-021-92058-6 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yuji Suzuki ◽

Keisuke Kakisaka ◽

Takuro Sato ◽

Ryouichi Mikami ◽

Hiroaki Abe ◽

...

Keyword(s):

Liver Transplantation ◽

Liver Injury ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Liver Injury ◽

Area Under The Curve ◽

Region Of Interest ◽

Free Survival ◽

Risk Of Death ◽

Poor Outcome

AbstractPatients with severe acute liver injury (SLI) usually recover spontaneously. However, some SLI patients progress to acute liver failure with varying degrees of hepatic encephalopathy. Acute liver failure is associated with high mortality and can be substantially reduced by liver transplantation. Therefore, distinguishing SLI patients who might progress to acute liver failure and are at a risk of death is important when evaluating patients needing liver transplantation. The present study aimed to determine whether technetium-99m-diethylenetriaminepentaacetic acid galactosyl human serum albumin (Tc-99m GSA) scintigraphy can predict the prognosis of patients with SLI. This prospective observational study included 69 SLI patients. The accuracy of Tc-99m GSA for predicting death or liver transplantation for 6 months was assessed. Between the two groups of patients stratified based on the cut-off values from the receiver operating characteristic curves, 6-month transplant-free survival was compared. Sixteen (23.2%) patients died or underwent liver transplantation from admission (poor outcome). The hepatic accumulation index was calculated by dividing the radioactivity of the liver region of interest by that of the liver-plus-heart region of interest at 15 min (i.e., LHL15). The LHL15 in the 16 patients (0.686) was significantly lower than that in survivors (0.836; P < 0.0001). The optimal LHL15 cut-off for distinguishing poor outcome and survival was 0.737 with a sensitivity of 81.3%, specificity of 88.7%, and area under the curve of 0.907 (95% CI, 0.832–0.981). When patients were divided into two groups based on the LHL15 cut-off value, the 6-month transplant-free survival was significantly lower in patients with an LHL15 level ≤ 0.737. Tc-99m GSA scintigraphy may help predict the prognosis of patients with SLI.

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Hepatoprotective effects of ginsenoside Rk3 in acetaminophen-induced liver injury in mice by activation of autophagy

Food & Function ◽

10.1039/d1fo02081a ◽

2021 ◽

Author(s):

Linlin Qu ◽

Rongzhan Fu ◽

xiaoxuan Ma ◽

Daidi Fan

Keyword(s):

Liver Injury ◽

Liver Failure ◽

Acute Liver Failure ◽

Acute Liver Injury ◽

Common Causes ◽

Hepatoprotective Effects

Acetaminophen (APAP)-induced acute liver injury (AIALI) is one of the most common causes of acute liver failure. Owing to the limitations of N-acetylcysteine (NAC), which is the only antidote currently...

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A case of cryptogenic pseudocirrhosis causing acute liver failure: when clinic and radiology work together

Italian Journal of Medicine ◽

10.4081/itjm.2019.1129 ◽

2019 ◽

Vol 13 (2) ◽

pp. 121-123

Author(s):

Martina Finocchi ◽

Ombretta Para ◽

Giacomo Zaccagnini ◽

Lorenzo Corbo ◽

Lucia Maddaluni ◽

...

Keyword(s):

Breast Cancer ◽

Liver Failure ◽

Acute Liver Failure ◽

Systemic Chemotherapy ◽

Acute Liver Injury ◽

Metastatic Breast ◽

International Normalized Ratio ◽

Caudate Lobe ◽

Oncologic Patients ◽

Liver Changes

It is known that a wild spectrum of hepatic manifestations can be common presentations of metastatic breast cancer. Pseudocirrhosis pattern has been often described as almost always secondary to systemic chemotherapy and it is defined by morphological liver changes that mimic cirrhosis including capsular retraction, nodularity, parenchyma atrophy and caudate lobe, radiologically identifiable. Acute liver injury is an occasional complication in oncologic patients, and it outlines an organ failure when there is evidence of encephalopathy and coagulopathy (international normalized ratio >1.5) in the absence of pre-existing liver disease, with an illness of <26 weeks duration. The two most common etiologies are leukemia/lymphoma followed by breast cancer but also in this case, liver is involved almost always after chemotherapy, hormonotherapy or radiotherapy. Here we present a case of rapid evolving acute liver failure presented as cryptogenic pseudocirrhosis without any evidence of primitive breast cancer but an incidental demonstration.

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