Paediatric acute liver failure is a devastating condition with high morbidity and mortality, which is challenging to manage for the hepatologist, intensivist, and associated specialists. Emergency liver transplantation is required for 10-20% of patients, but for 10% of critically ill children, liver transplantation is deemed unsuitable; the child might be too unwell, or the underlying cause might carry a poor prognosis. Other social, logistical, or ethical considerations are often relevant. Liver transplantation when a patient is too unwell creates perioperative risk to the child that could lead to morbidity, mortality, and potential graft wastage, which is detrimental for others on the waiting list. Donor liver scarcity should prompt an evaluation of whether a transplant is justified through a holistic multidisciplinary lens that considers medical, social, logistical, and ethical concerns. In this Review, we explore, from a multidisciplinary perspective, why a critically unwell child with paediatric acute liver failure might be unsuitable for liver transplantation.

中文翻译：

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儿科急性肝衰竭：关于危重儿童何时不适合肝移植的多学科视角。


儿科急性肝衰竭是一种具有高发病率和死亡率的破坏性疾病，对于肝病学家、重症监护医师和相关专家来说，管理起来是一项挑战。10-20% 的患者需要紧急肝移植，但 10% 的危重儿童被认为不适合肝移植;孩子可能身体不适，或者根本原因可能预后不佳。其他社会、后勤或道德考虑因素通常是相关的。当患者身体不适时进行肝移植会给孩子带来围手术期风险，这可能导致发病率、死亡率和潜在的移植物浪费，这对等待名单上的其他人是有害的。供体肝脏稀缺应促使通过考虑医学、社会、后勤和伦理问题的整体多学科视角来评估移植是否合理。在本综述中，我们从多学科的角度探讨了为什么患有儿科急性肝衰竭的危重儿童可能不适合肝移植。