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Effect of Liver Transplantation in Children with Fulminant Hepatitis

Journal of the Korean Pediatric Society 2000;43(4):535-542.
Published online April 15, 2000.
Effect of Liver Transplantation in Children with Fulminant Hepatitis
Young Mee Seo1, Bo Hwa Choi1, Kyung Mo Kim1, Kwang Min Park2, Young Joo Lee2, Sung Gyu Lee2
1Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
2Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
전격성 간염의 소아에서 간이식의 치료 효과
서영미1, 최보화1, 김경모1, 박광민2, 이영주2, 이승규2
1울산의대 서울중앙병원 소아과
2울산의대 서울중앙병원 외과
Abstract
Purpose
: Liver transplantation(LT) is regarded as an important management option for fulminant hepatitis(FH), which is associated with considerable mortality under conservative management. The aim of this study was to evaluate the outcome of children with FH according to management.
Methods
: We reviewed medical records of patients presented with FH from January 1994 until April 1999. The children were grouped according to the treatment. Group A was classified for supportive treatment only and group B for supportive treatment plus LT. Children were considered as candidates for LT if the level of factor V decreased to below 20% of normal or the patient`s condition deteriorated despite intensive care during the initial 48 hours. Underlying disease, duration after jaundice, grade of encephalopathy, laboratory findings, treatment and outcomes were analyzed.
Results
: The study group comprised 7 females and 8 males aged from 8 months to 15 years old(median age of 4 years). The causes of FH were Wilson disease(4 cases), Epstein-Barr virus infection(1 case), drug(1 case) and idiopathic(9 cases). There were 5 children in group A and 10 in group B, and there were no significant differences in age, sex ratio, underlying diseases, grade of hepatic encephalopathy and laboratory findings between the two groups. One out of 5 in group A and 9 out of 10 in group B survived. But all the children in group A who met the criteria for LT and received only supportive care died. One out of 10 in group B died because of grade IVa hepatic encephalopathy which advanced to brainstem herniation.
Conclusion
: This study showed that patients who were managed with supportive care only, although LT was indicated, died and that 9 out of 10 who received LT survived. Therefore, we suggest LT should be considered in the management of FH.
Key Words: Fulminant hepatitis, Children, Liver transplantation


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