Score PELOD : indice précoce de mortalité pédiatrique des transplantations hépatiques pour hépatite fulminante
Hepatic transplantation is the only definitive treatment for acute liver failure for those children who do not recover spontaneously.  Early indicators of prognosis in acute liver failure have been studied in adults in order to define the indication for liver transplantation.  The course of the disease in the pediatric population, particularly with respect to hepatic encephalopathy, differs from that in adults.  Consequently, these criteria are not applicable to the pediatric population.  Primary objective: To determine the risk markers for mortality in children receiving liver transplantation for acute liver failure.  Liver failure is defined as being severe failure without prior liver disease within the last eight weeks. Method: A retrospective study was conducted with children who had received a liver transplantation for acute liver failure at Sainte-Justine’s Hospital between 1985 and 2005.  Data including the PELOD (Pediatric Logistic Organ Dysfunction) Score, a clinical score (0-71) of illness severity in children in intensive care, were recorded from patients’ charts.  Results: 14 children, aged from five months to sixteen years old, were transplanted for fulminant liver failure.  Nine (64%) survived and five (36%) died.  The need for mechanical ventilation was associated with a poorer survival (p= 0,027).  Of all of the children who had a PELOD Score variation inferior to five, between admission and transplantation, 88% survived.  None of those with a score variation superior to five survived (p=0,027).  Conclusion: In our single centre study, the PELOD Score variation was a pre-transplant marker of mortality after liver transplantation for pediatric acute liver failure.
Liver transplantation Pediatric acute liver failure PELOD Score