Valproic Acid-Associated Acute Liver Failure in Children: Case Report and Analysis of Liver Transplantation Outcomes in the United States - 02/08/11
, Dale King, MD b, Laurence S. Magder, PhD, MPH c, John A. Ozolek, MD d, George V. Mazariegos, MD e, Benjamin L. Shneider, MD b
Reprint requests: Ayse L. Mindikoglu, MD, MPH, Assistant Professor of Medicine, Division of Gastroenterology and Hepatology, University of Maryland School of Medicine, 22 S Greene St, N3W50, Baltimore, MD 21201-1595.Abstract |
Objective |
To determine whether valproic acid (VPA)-associated acute liver failure (ALF; VPA-ALF) explains the poor outcomes after liver transplantation (LT) in children.
Study design |
Organ Procurement and Transplantation Network data of pediatric patients who underwent LT for VPA-ALF and ALF caused by other drugs (non-VPA-drug-induced acute liver failure [DIALF]) were analyzed. Pre- and post-transplant variables and post-LT survival were compared between VPA-ALF and non-VPA-DIALF.
Results |
Seventeen children were transplanted for VPA-ALF. Of the 17 children, 82% died within 1 year of LT. Pre- and post-transplant parameters of VPA versus non-VPA-DIALF were comparable with two exceptions. The median alanine aminotransferase level at transplant was remarkably lower in VPA-ALF compared with non-VPA-DIALF (45 versus 1179 IU/L, P = .004). One-year survival probability was worse in VPA-ALF than non-VPA-DIALF (20% versus 69%, P < .0001). Median post-LT survival time for VPA-ALF was 2.8 months.
Conclusion |
Children who underwent LT for VPA-ALF had a significantly lower survival probability than children with non-VPA-DIALF. Current data suggest that VPA-ALF in children represents an “unmasking” of mitochondrial disease. VPA-ALF should be a contraindication for LT, even in the absence of a documented mitochondrial disease.
Le texte complet de cet article est disponible en PDF.Mots-clés : ALF, ALT, DIALF, INR, LT, VPA
Plan
| Supported in part by Grant Number 1 K23 DK089008-01 from the National Institutes of Health National Institute of Diabetes and Digestive and Kidney Diseases (A.L.) and its contents are solely the responsibility of the authors and do not necessarily represent the official views of the National Institute of Diabetes and Digestive and Kidney Diseases or the NIH; and also supported in part by Health Resources and Services Administration contract 234-2005-370011C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors declare no conflicts of interest. |
Vol 158 - N° 5
P. 802-807 - mai 2011 Retour au numéro
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