Paediatric Acute Liver Failure; A Retrospective Review from a South African Tertiary Institution

Acute liver failure describes a fatal clinical syndrome resulting from extensive loss of functional liver parenchymal mass due to severe liver damage triggered by various factors. Early recognition and initiation of therapy may improve outcomes and reduce the need for liver transplantation, a treatment modality not universally available in resource constraint areas. There is paucity of data describing this syndrome in Sub-Saharan Africa in children.

Objective: The study aims to retrospectively review and determine the clinical presentation, aetiology, complications and outcomes of children admitted with acute liver failure at the Red Cross War Memorial Children`s Hospital (RCWMCH).

Methods: Records of children under 13 years admitted at RCWMCH from January 2005 to December 2016 with acute liver failure were retrospectively reviewed, after obtaining ethical approval. Patients with pre-existing evidence of chronic liver disease were excluded. Demographic variables, clinical presentation and investigations were captured, with determination of outcomes at 6 weeks of diagnosis.

Results: The study included 24 children, age range varied from 0.2 months to 130 months (Average 25.6 months). Diarrhoea, jaundice, respiratory distress, hepatomegaly and encephalopathy were common clinical features. Etiology was infection in 37.2 % of cases (n=9, 2 of these had autoimmune hepatitis co-morbidity). Hepatitis A was the most common infectious cause (n=4). Causes were indeterminable in 29.2%. Two patients had autoimmune hepatitis without co-morbidity; Reye syndrome 12.5 %, and 17% had miscellaneous causes.

Conclusions: Viral hepatitis A was the leading infectious cause of acute liver failure in this cohort, and 29.2 % cases were indeterminable. INR>4 and Bilirubin >210umol/l were predictors of poor outcome. A multicentered study in the African setting is recommended to better understand this clinical syndrome and outcomes.