The outcome of children with acute liver failure admitted to Tygerberg Children’s Hospital January 2009 – December 2013

Abumhara, Salah (2018-10)

Thesis (MMed)--Stellenbosch University, 2018.

Thesis

ENGLISH ABSTRACT: Background: Acute Liver Failure is a rapidly progressive and potentially life-threatening disease. There is scarcity of data from SA regarding Paediatric ALF and therefore its incidence remains unknown. Paediatric acute liver failure is defined according to the PALF study group definition. Objective: to evaluate the aetiology and outcome of ALF in children in a tertiary healthcare facility in the Western Cape Province, SA. Methods/Design: A retrospective review of the medical records of paediatric patients presented with ALF between January 2009 and December 2013. The demographics, aetiologies and outcomes were recorded and, based on the final outcome, patients were categorised as either survivors or nonsurvivors. Setting: Paediatric Gastroenterology Unit, Tygerberg Hospital, SA. Results: Nineteen children (12 boys), aged 5 weeks to 6 years (mean age 18 months), were identified with ALF during the 5-year study period. The ALF causes were: infective (68.4%), INH-related (10.5%) and indeterminate (10.5%). One child presented with toxin-induced ALF and an underlying metabolic cause was suspected in one infant. Of the infective aetiologies, hepatitis A infection was the most common (10/19) and was found to be associated with the highest mortality. Other viral causes also had fatal outcomes. The overall mortality was 52.9% and children with aetiologies other than acute viral hepatitis were more likely to recover spontaneously. Conclusion: Our study demonstrated that Hepatitis A infection is the single most common cause of ALF in our small cohort of patients. Measuring the risk of HAV-associated morbidity and mortality as well as the cost of LT and its complications and the need for lifelong immunosuppression therapy against the cost-effectiveness and benefit of Hepatitis A vaccine favours the introduction of hepatitis A vaccine in the EPI in SA. There is a need for larger, multicenter and prospective studies to better evaluate the aetiology and outcome of ALF in children, the results of which will surely contribute to the establishment of a national database to determine the number of children with ALF who potentially require LT in SA.

AFRIKAANSE OPSOMMING: Geen opsomming

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