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Liver Failure and Haematopoietic Stem Cell Transplantation

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Liver Diseases in the Pediatric Intensive Care Unit

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Abstract

The number of patients admitted to paediatric intensive care units (PICU) following haematopoietic stem cell transplantation (HSCT) is growing, with increasingly complex management. The liver, like other organs, is subject to multiple injuries such as conditioning and associated treatment toxicity, parenteral nutrition, sepsis, and hepatotropic viruses. In addition, there may be pre-HSCT liver dysfunction related to the underlying disease. Liver injury is often multi-factorial and is not in itself a reason for admission to the PICU. The main life-threatening hepatic cause of PICU admission is sinusoidal obstruction syndrome (SOS), formerly known as veno-occlusive disease, whose diagnostic criteria have recently been redefined in children. SOS is characterized by endothelial damage to the hepatic sinusoids leading to their obstruction. Resulting capillary leakage and portal hypertension lead to fluid overload, significant ascites, respiratory failure and multiple organ dysfunction. Management is based on early symptomatic supportive care in addition to defibrotide.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada

    Laurence Tabone

  2. Hematology-Oncology Unit, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada

    Pierre Teira

  3. Department of Pharmacist, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada

    Annie Lavoie

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  1. Laurence Tabone
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  2. Pierre Teira
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  3. Annie Lavoie
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Correspondence to Pierre Teira .

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Editors and Affiliations

  1. Pediatric Intensive Care Unit - Department of Pediatrics of Sainte Justine Hospital, University of Montreal, Montréal, QC, Canada

    Philippe Jouvet

  2. Division of Gastroenterology, Hepatology & Nutrition, Department of Pediatrics of Sainte Justine Hospital, University of Montreal, Montréal, QC, Canada

    Fernando Alvarez

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Tabone, L., Teira, P., Lavoie, A. (2021). Liver Failure and Haematopoietic Stem Cell Transplantation. In: Jouvet, P., Alvarez, F. (eds) Liver Diseases in the Pediatric Intensive Care Unit. Springer, Cham. https://doi.org/10.1007/978-3-030-79132-2_9

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  • DOI: https://doi.org/10.1007/978-3-030-79132-2_9

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