Akman Sezin Asik, Cakir Murat, Baran Masallah, Arikan Cigdem, Yuksekkaya Hasan Ali, Tumgor Gokhan, Saz Eylem Ulas, Zeytunlu Murat, Kilic Murat, Aydogdu Sema
Department of Pediatric Gastroenterology Hepatology and Nutrition, Ege University, Bornova, Izmir, Turkey.
Pediatr Transplant. 2009 Dec;13(8):1034-40. doi: 10.1111/j.1399-3046.2008.01119.x. Epub 2009 Feb 6.
ALF is characterized by sudden onset, impaired liver function, jaundice and encephalopathy, without previous liver disease. We analyzed the patients who underwent LT due to toxic agent induced ALF to raise community awareness about preventing the toxic agent induced ALF. Five children (three boys, two girls) underwent LT due to toxic agent ingestion. Toxic agents were mushroom poisoning (n = 2), Datura stramonium (n = 1), yellow phosphorous (n = 1) and INH (n = 1). On admission, one patient had stage IV, two had stage III and two had stage II hepatic encephalopathy but worsened during the follow-up. One patient had renal failure, and three patients required mechanical ventilation. Three patients underwent LRLT and others from a DD. Post-operative complications were managed by supportive managements successfully, and overall all the patients are alive (100% survival) without any organ sequelae. Although outcome of these patients are excellent, ALF may be prevented in these cases by educating the public about consuming mushrooms and toxic effects of wild plants, prohibiting fireworks and serial liver enzyme measurements after initiating INH.
急性肝衰竭的特点是起病急、肝功能受损、黄疸和脑病，既往无肝病。我们分析了因毒性药物导致急性肝衰竭而接受肝移植的患者，以提高公众对预防毒性药物所致急性肝衰竭的认识。五名儿童（三名男孩，两名女孩）因摄入毒性药物而接受肝移植。毒性药物分别为蘑菇中毒（2例）、曼陀罗（1例）、黄磷（1例）和异烟肼（1例）。入院时，1例患者为IV期肝性脑病，2例为III期，2例为II期，但在随访期间病情恶化。1例患者出现肾衰竭，3例患者需要机械通气。3例患者接受了左外叶肝移植，其他患者接受了尸体供肝肝移植。术后并发症通过支持治疗成功处理，所有患者均存活（100%生存率），无任何器官后遗症。尽管这些患者的预后良好，但通过对公众进行食用蘑菇和野生植物毒性影响的教育、禁止烟花以及在开始使用异烟肼后进行系列肝酶检测，这些病例中的急性肝衰竭是可以预防的。
