Extracorporeal liver support therapies for children

Acute liver failure (ALF) is a rare but life-threatening disorder in children. The spectrum of etiologies varies with age, and the presentation symptomatology ranges from mild physical findings to encephalopathy, bleeding due to aberrancies in coagulation, and shock. The goals of treatment are emergent stabilization and support of vital organs with the only established treatment being transplantation. One-third of children recover with supportive management, whereas the other two-thirds require emergency liver transplantation. The majority of children with acute-on-chronic liver failure and those with progressive chronic liver disease also require liver transplantation. Since organ availability is limited and considerable bridging time may be required, extracorporeal liver support therapies (ELS) are increasingly applied. In this chapter, we will review the available epidemiology of ALF in children, the argument for use of ELS, the available methodology and equipment to perform ELS, and the data surrounding ELS use and outcome in pediatric patients. As more data emerge about the patient characteristics and epidemiology of pediatric ALF, additional opportunities to determine the efficacy of ELS in children will become available. Existing data are preliminary, but encouraging. An expanded, collaborative study will, however, be required to determine the optimal management for children with worsening liver function and its impact on short- and long-term outcomes.