The only proven
therapy for patients unlikely to recover from
acute liver failure (ALF) is
liver transplantation. Correct diagnosis of these individuals and rapid referral to a transplant center are crucial. We evaluated 12 pediatric patients with ALF who underwent
liver transplantation (LT) at our institution during a 3-year period. The reasons for
transplantation were
hepatitis A (3 patients); non-A, non-E
hepatitis (3);
autoimmune hepatitis (1); fulminant
Wilson's disease (3); Amanita phalloides (
mushroom) poisoning (1); and
hepatitis B and
toxic hepatitis with
leflunomide treatment (1). Seven of the participants were female and five were male (mean age, 9.1 +/- 4.2 years). Three received right liver-lobe grafts, one received a whole liver graft, and the remainder received left or left-lateral liver lobe grafts. All patients recovered from
hepatic coma the second postoperative day. Two patients died at postoperative days 57 and 71 due to
adult respiratory distress syndrome and
sepsis with multiorgan failure, respectively. One patient required retransplantation because of chronic rejection 7 months after the initial
transplantation. That patient died 10 days after retransplantation because of
sepsis. Nine patients were healthy at follow-up (range, 2-46 months). LT is the only treatment option for ALF in patients in countries with low organ-donation rates. In this scenario, donor preparation in a limited time frame is difficult. We have been able to decrease the duration of donor preparation to approximately 4 hours (including biopsy of the donated liver tissue).