Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN)

Bikrant Bihari Lal¹, Rajeev Khanna¹, Vikrant Sood¹, Seema Alam², Aabha Nagral^{3

4}, Aathira Ravindranath⁵, Aditi Kumar⁶, Akash Deep⁷, Amrit Gopan⁸, Anshu Srivastava⁹, Arjun Maria¹⁰, Arti Pawaria¹¹, Ashish Bavdekar¹², Gaurav Sindwani¹³, Kalpana Panda¹⁴, Karunesh Kumar¹⁵, Malathi Sathiyasekaran¹⁶, Maninder Dhaliwal¹⁷, Marianne Samyn¹⁸, Maya Peethambaran¹⁹, Moinak Sen Sarma⁹, Moreshwar S Desai²⁰, Neelam Mohan²¹, Nirmala Dheivamani²², Piyush Upadhyay²³, Pratibha Kale²⁴, Rakhi Maiwall²⁵, Rohan Malik²⁶, Roshan Lal Koul²⁷, Snehavardhan Pandey²⁸, Somashekara Hosaagrahara Ramakrishna²⁹, Surender Kumar Yachha³⁰, Sadhna Lal³¹, Sahana Shankar³², Sajan Agarwal³³, Shivani Deswal³⁴, Smita Malhotra³⁵, Vibhor Borkar³⁶, Vipul Gautam³⁷, Viswanathan M Sivaramakrishnan³⁸, Anil Dhawan¹⁸, Mohamed Rela³⁹, Shiv Kumar Sarin²⁵

Affiliations

¹ Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
² Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. seema_alam@hotmail.com.
³ Department of Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India.
⁴ Apollo Hospital, Navi Mumbai, India.
⁵ Department of Pediatric Gastroenterology, Apollo BGS Hospital, Mysuru, Karnataka, India.
⁶ Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India.
⁷ Department of Pediatric Intensive Care, King's College Hospital, London, UK.
⁸ Department of Pediatric Gastroenterology and Hepatology, Sir H.N Reliance Foundation Hospital, Mumbai, India.
⁹ Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
¹⁰ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
¹¹ Department of Pediatric Hepatology and Gastroenterology, Amrita Institute of Medical Sciences, Faridabad, India.
¹² Department of Pediatrics, KEM Hospital and Research Centre, Pune, India.
¹³ Department of Organ Transplant Anesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India.
¹⁴ Department of Pediatrics, Institute of Medical Sciences & SUM Hospital, Bhubaneshwar, India.
¹⁵ Department of Pediatric Gastroenterology and Liver Transplantation, Indraprastha Apollo Hospitals, New Delhi, India.
¹⁶ Department of Paediatric Gastroenterology, Rainbow Children's Hospital, Chennai, India.
¹⁷ Department of Pediatric Intensive Care, Amrita Institute of Medical Sciences, Faridabad, India.
¹⁸ Department of Pediatric Hepatology, King's College Hospital, London, UK.
¹⁹ Department of Pediatric Gastroenterology and Hepatology, VPS Lakeshore Hospital, Kochi, Kerala, India.
²⁰ Department of Paediatric Critical Care and Liver ICU, Baylor College of Medicine &Texas Children's Hospital, Houston, TX, USA.
²¹ Department of Pediatric Gastroenterology and Hepatology, Medanta the Medicity Hospital, Gurugram, India.
²² Department of Paediatric Gastroenterology, Institute of Child Health and Hospital for Children, Egmore, Chennai, India.
²³ Department of Pediatrics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
²⁴ Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India.
²⁵ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
²⁶ Department of Pediatric Gastroenterology and Hepatology, All India Institute of Medical Sciences, New Delhi, India.
²⁷ Department of Neurology, Institute of Liver and Biliary Sciences, New Delhi, India.
²⁸ Department of Pediatric Hepatology and Liver Transplantation, Sahyadri Superspeciality Hospital Pvt Ltd Pune, Pune, India.
²⁹ Department of Pediatric Hepatology and Liver Transplantation, Glenegales Global Health City, Chennai, India.
³⁰ Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Sakra World Hospital, Bangalore, India.
³¹ Division of Pediatric Gastroenterology and Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
³² Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mazumdar Shaw Medical Centre, Narayana Health City, Bangalore, India.
³³ Department of Pediatric Gastroenterology and Hepatology, Gujarat Gastro Hospital, Surat, Gujarat, India.
³⁴ Department of Pediatric Gastroenterology, Hepatology and Liver Transplant, Narayana Health, DLF Phase 3, Gurugram, India.
³⁵ Department of Pediatric Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, India.
³⁶ Department of Paediatric Hepatology and Gastroenterology, Nanavati Max Super Speciality Hospital, Mumbai, Maharashtra, India.
³⁷ Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Max Superspeciality Hospital, New Delhi, India.
³⁸ Department of Paediatric Gastroenterology and Hepatology, Apollo Children's Hospital, Chennai, India.
³⁹ Department of Liver Transplantation and HPB (Hepato-Pancreatico-Biliary) Surgery, Dr. Rela Institute & Medical Center, Chennai, India.

PMID: 39212863
DOI: 10.1007/s12072-024-10720-3

Review

Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN)

Bikrant Bihari Lal et al. Hepatol Int. 2024 Oct.

. 2024 Oct;18(5):1343-1381.

doi: 10.1007/s12072-024-10720-3. Epub 2024 Aug 30.

Authors

Affiliations

¹ Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.
² Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India. seema_alam@hotmail.com.
³ Department of Gastroenterology, Jaslok Hospital and Research Center, Mumbai, India.
⁴ Apollo Hospital, Navi Mumbai, India.
⁵ Department of Pediatric Gastroenterology, Apollo BGS Hospital, Mysuru, Karnataka, India.
⁶ Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India.
⁷ Department of Pediatric Intensive Care, King's College Hospital, London, UK.
⁸ Department of Pediatric Gastroenterology and Hepatology, Sir H.N Reliance Foundation Hospital, Mumbai, India.
⁹ Department of Pediatric Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
¹⁰ Division of Pediatric Gastroenterology, Hepatology and Nutrition, Institute of Child Health, Sir Ganga Ram Hospital, New Delhi, India.
¹¹ Department of Pediatric Hepatology and Gastroenterology, Amrita Institute of Medical Sciences, Faridabad, India.
¹² Department of Pediatrics, KEM Hospital and Research Centre, Pune, India.
¹³ Department of Organ Transplant Anesthesia and Critical Care, Institute of Liver and Biliary Sciences, New Delhi, India.
¹⁴ Department of Pediatrics, Institute of Medical Sciences & SUM Hospital, Bhubaneshwar, India.
¹⁵ Department of Pediatric Gastroenterology and Liver Transplantation, Indraprastha Apollo Hospitals, New Delhi, India.
¹⁶ Department of Paediatric Gastroenterology, Rainbow Children's Hospital, Chennai, India.
¹⁷ Department of Pediatric Intensive Care, Amrita Institute of Medical Sciences, Faridabad, India.
¹⁸ Department of Pediatric Hepatology, King's College Hospital, London, UK.
¹⁹ Department of Pediatric Gastroenterology and Hepatology, VPS Lakeshore Hospital, Kochi, Kerala, India.
²⁰ Department of Paediatric Critical Care and Liver ICU, Baylor College of Medicine &Texas Children's Hospital, Houston, TX, USA.
²¹ Department of Pediatric Gastroenterology and Hepatology, Medanta the Medicity Hospital, Gurugram, India.
²² Department of Paediatric Gastroenterology, Institute of Child Health and Hospital for Children, Egmore, Chennai, India.
²³ Department of Pediatrics, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India.
²⁴ Department of Microbiology, Institute of Liver and Biliary Sciences, New Delhi, India.
²⁵ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
²⁶ Department of Pediatric Gastroenterology and Hepatology, All India Institute of Medical Sciences, New Delhi, India.
²⁷ Department of Neurology, Institute of Liver and Biliary Sciences, New Delhi, India.
²⁸ Department of Pediatric Hepatology and Liver Transplantation, Sahyadri Superspeciality Hospital Pvt Ltd Pune, Pune, India.
²⁹ Department of Pediatric Hepatology and Liver Transplantation, Glenegales Global Health City, Chennai, India.
³⁰ Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Sakra World Hospital, Bangalore, India.
³¹ Division of Pediatric Gastroenterology and Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
³² Division of Pediatric Gastroenterology and Hepatology, Department of Pediatrics, Mazumdar Shaw Medical Centre, Narayana Health City, Bangalore, India.
³³ Department of Pediatric Gastroenterology and Hepatology, Gujarat Gastro Hospital, Surat, Gujarat, India.
³⁴ Department of Pediatric Gastroenterology, Hepatology and Liver Transplant, Narayana Health, DLF Phase 3, Gurugram, India.
³⁵ Department of Pediatric Gastroenterology and Hepatology, Indraprastha Apollo Hospitals, New Delhi, India.
³⁶ Department of Paediatric Hepatology and Gastroenterology, Nanavati Max Super Speciality Hospital, Mumbai, Maharashtra, India.
³⁷ Department of Pediatric Gastroenterology, Hepatology and Liver Transplantation, Max Superspeciality Hospital, New Delhi, India.
³⁸ Department of Paediatric Gastroenterology and Hepatology, Apollo Children's Hospital, Chennai, India.
³⁹ Department of Liver Transplantation and HPB (Hepato-Pancreatico-Biliary) Surgery, Dr. Rela Institute & Medical Center, Chennai, India.

PMID: 39212863
DOI: 10.1007/s12072-024-10720-3

Abstract

Timely diagnosis and management of pediatric acute liver failure (PALF) is of paramount importance to improve survival. The Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition invited national and international experts to identify and review important management and research questions. These covered the definition, age appropriate stepwise workup for the etiology, non-invasive diagnosis and management of cerebral edema, prognostic scores, criteria for listing for liver transplantation (LT) and bridging therapies in PALF. Statements and recommendations based on evidences assessed using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were developed, deliberated and critically reappraised by circulation. The final consensus recommendations along with relevant published background information are presented here. We expect that these recommendations would be followed by the pediatric and adult medical fraternity to improve the outcomes of PALF patients.

Keywords: Acute liver failure; Bridging therapies; Continuous renal replacement therapy; Diagnosis; Guidelines; Liver transplantation; Management; Molecular adsorbent recirculating system; Non-invasive assessment of cerebral edema; Pediatric acute liver failure; Therapeutic plasma exchange.

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References

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Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN)

Affiliations

Diagnosis and management of pediatric acute liver failure: consensus recommendations of the Indian Society of Pediatric Gastroenterology, Hepatology, and Nutrition (ISPGHAN)

Authors

Affiliations

Abstract

References

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LinkOut - more resources

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Medical