Acute Liver Failure (ALF) occurs when a large number of liver cells die or are damaged within a short period of time, and the liver is unable to perform its multiple functions. There are many reasons for acute liver failure in children, including:
- Toxins (poisons) that accumulate due to excessive dosages of drugs such as acetaminophen, but there are also many other substances that can cause liver damage.
- Viral infections such as Hepatitis A and B, herpes virus, Epstein-Barr virus, and others.
- Metabolic disorders caused by a problem in the natural chemical processing that occurs in the liver, which hinders its proper functioning. Some of these disorders can have an immediate impact, such as Galactosemia, while others may manifest after many years, such as Wilson's Disease.
- Autoimmune disorders where the body sees the liver as a foreign invader and activates the immune system against it.
In a significant percentage of children who experience acute liver failure, the exact cause cannot be identified, despite thorough investigation. It's estimated that a large portion of these cases result from unidentified viral diseases that often resolve on their own.
The symptoms of acute liver failure can be very mild and nonspecific at the beginning, and there might even be no symptoms at all. However, children can quickly progress to jaundice or encephalopathy. Additionally, there might be bleeding tendencies in the legs due to low protein levels in the blood and also bleeding. The diagnosis of acute liver failure is carried out through a series of tests, but it's important to note that treatment at a specialized pediatric liver center is crucial for accurate and rapid diagnosis. The treatment for acute liver failure is complex and involves several stages. Initial treatment includes supportive and focused care aimed at helping the body cope with the loss of liver function. For example, providing substitutes for sugars and protein breakdown and treating encephalopathy. Simultaneously, additional investigations are conducted to characterize the cause of liver failure. This is vital to direct treatment to the specific issue. This investigation may involve imaging tests (such as ultrasound) and liver biopsy.
The long-term outcome of acute liver failure depends on the underlying cause of the disorder. Generally, the liver has an excellent ability to recover, and children may fully heal. In rare cases where it appears that the liver is not recovering, consideration might be given to referral to a transplant center for evaluation towards the possibility of liver transplantation. It's important to emphasize that such cases are extremely rare. Even for children requiring transplantation, the outcomes are promising with a high success rate and long-term survival.