There have been very few reports dealing with
liver failure related to
hepatitis A in children. Moreover, the criteria usually used for selecting patients with
fulminant hepatitis A for
liver transplantation have not been evaluated in children. Therefore, the current study was conducted retrospectively in a single French urban pediatric
liver transplantation center to serve as a reminder of the potential severity of
hepatitis A in children and to identify predictors of outcome. Children were selected by chart review using a data base system and were grouped according to outcome for analyses purposes. Over a 15-year period, 24 children with
hepatitis A showed evidence of
liver failure, including 6 children who did not develop
hepatic encephalopathy, 7 children in whom
encephalopathy occurred but resolved spontaneously, and 11 children in whom death or
liver transplantation was the outcome. The mean age at onset was 6.5 years. Those with the most rapid onset of
liver failure from onset of
jaundice had the best chance of recovery without developing
encephalopathy. Otherwise, no predictive factors of outcome were found at onset of
liver failure. Among the 18 children who developed
encephalopathy, the best early prognostic
indicator of a poor outcome irrespective of the grade of
encephalopathy, appeared to be a prothrombin time level below 21% of normal combined with a serum
bilirubin level above 400 micromol/L. Therefore, these two prognostic indicators may be helpful in deciding
liver transplantation in children with
hepatitis A-induced
fulminant liver failure.