Acute Liver Failure in Children

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Background

Acute liver failure (ALF) in children is a rare but challenging disease. It is a complex clinical syndrome with a wide variety of age–dependent etiologies and clinical symptoms. The clinical course and outcome also varies according to age groups, geographical distribution, stage of encephalopathy and degree of coagulopathy. ALF accounts for 10-16 % of the pediatric liver transplants in United Kingdom and United States annually. The liver is the only organ which has the ability to regenerate after an acute insult, meaning there are 4 different outcomes expected in ALF: survival with native liver, survival post-transplant, death awaiting liver transplant, death following liver transplantation. To understand the management strategies in ALF, it is important to understand what kills in ALF - systemic inflammation, sepsis with multisystem organ failure, and/or cerebral oedema with raised intra-cranial pressure.

A wealth of research is being conducted all around the globe to understand various aspects of this disease better and, in the last 2-3 decades, data has emerged which shows that, depending on etiology, the percentage of children surviving with just medical therapy alone has increased substantially, thereby obviating the need for liver transplant. Since the disease is rare, the evidence base remains scarce. There are controversies starting from the definition of ALF, to scoring systems in ALF to predict the need for liver transplantation or spontaneous liver recovery or mortality, to timing, dose and anticoagulation of extracorporeal liver assist devices.

Collaborations and manuscripts describing experiences from all over the globe will help in understanding the disease better and elucidating the immune basis in ALF, as well as specific changes in the coagulation system (especially paradoxical hemostasis). Moreover, comparing etiology matched prognosis and management strategies in places with access to liver transplantation versus those where there is no access to liver transplantation will help us to understand what supportive medical measures can help in spontaneous liver recovery.

The goal of this Research Topic is to address the controversies in the various aspects of diagnosis and management of pediatric ALF, including definition, etiology, and clinical presentation. We aim to discuss the treatment of pediatric acute liver failure, with a focus on: controversies in diagnosis, immunology, coagulation, scoring systems, extracorporeal liver assist devices (biologic and non-biologic including), newer techniques of neuro monitoring and neuro-management, hepatocyte transplant, acute kidney injury, and anesthetic considerations during liver transplant. We anticipate that this collection will empower the reader with confidence in managing children with ALF.

Important note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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