Advances in Liver Failure and Management

  • Moreshwar Desai
  • Ayse Akcan-ArikanEmail author


Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) in children are rare but catastrophic clinical conditions with a high mortality and morbidity. Massive hepatocyte necrosis leads to profound impairment in synthetic, excretory, and detoxifying ability of the liver and leads to coagulopathy, jaundice, and encephalopathy. Circulating inflammatory mediators and toxins lead to multi-organ failure and death. As there are yet no treatment options for reversing or halting hepatocellular necrosis, current therapies focus more on supporting the failing organs, while the liver either spontaneously regenerates or child undergoes a liver transplant. Continuous renal replacement therapy (CRRT) forms one of such essential pillars of support implemented to successfully manage a critically ill child with ALF or ACLF. CRRT is either used alone or in combination of other blood purification modalities to attenuate the deleterious effects of a failing liver in the host. This chapter discusses the pathophysiology of liver failure, indications, benefits, and challenges of CRRT in pediatric liver failure.


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Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Pediatrics, Section of Pediatric Critical CareBaylor College of Medicine, Texas Children’s HospitalHoustonUSA
  2. 2.Liver Intensive Care UnitTexas Children’s HospitalHoustonUSA
  3. 3.Department of Pediatrics, Sections of Critical Care and NephrologyBaylor College of Medicine, Texas Children’s HospitalHoustonUSA
  4. 4.Extracorporeal Liver SupportTexas Children’s HospitalHoustonUSA
  5. 5.Critical Care NephrologyTexas Children’s HospitalHoustonUSA

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