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Paediatric liver transplantation: critical care 

Paediatric liver transplantation: critical care
Chapter:
Paediatric liver transplantation: critical care
Author(s):

Richard Neal

and Oliver Bagshaw

DOI:
10.1093/med/9780199651429.003.0026
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date: 22 August 2019

Children requiring liver transplantation invariably need to spend time on the intensive care unit: some preoperatively due to the underlying liver disease and most postoperatively following transplantation. Acute liver failure (ALF) often leads to multi-organ failure and intracranial hypertension, requiring rapid assessment and stabilization before transfer to the paediatric intensive care unit. It is associated with a high mortality in those not receiving a transplant, especially in infants with metabolic liver disease and familial erythrophagocytosis, and in children less than 10 years of age with seronegative hepatitis. Severe coagulopathy (prothrombin time>55 s), encephalopathy (grade 3–4), prolonged duration of illness before onset of hepatic encephalopathy, and coexisting renal failure are other poor prognostic factors. The management of ALF includes treatment of the primary disorder when possible, prevention and treatment of complications, and early evaluation for liver transplantation.

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