Shahid Akhter, editor, ETHealthworld spoke Dr Robert H Squires, Prof. of Pediatrics, Transplant Hepatology, Children’s Hospital of Pittsburg, USA to know more about the progress and challenges in pediatric hepatology.
Acute Liver Failure in children – Trends
Acute liver failure in children is rare and the causes of liver failure vary by location. For instance, in India the most common causes of liver failure are viral hepatitis A, hepatitis E. In the United States the most common cause of acute liver failure are various metabolic or genetic defects, medications but in many children we don’t find a reason for them to have acute liver failure.
Acute Liver Failure in Children- Causes and management
Treatment depends on the cause, there are no specific treatment for viral infections other than herpes infection which we see more in the United States than in India but there are no treatments for hepatitis A or B, it just has to run its course. There are children whose liver dies because they have liver failure and because of that one has to do liver transplantation to save the child’s life.
Liver fibrosis & inflammation in children with liver transplantation
Liver transplantation in children has become very successful in the last 20 years. 90 percent of children who had a liver transplant are surviving to a year and that was unheard of 20 years ago. Now that they are surviving for a year what we are seeing is an increasing number of patients who have some inflammation in the liver and even scarring of fibrosis despite normal liver tests and a low amount of immune suppression. The challenge is how to manage that, you would like to minimize the amount of immune suppression they are getting because of the long term side effects of the medicines used for immune suppression but you don’t want them to get into a pattern of chronic rejection which can result in having to replace the liver transplant. So there are many questions that we have right now of the cause for inflammation and fibrosis in 5-10 years after transplantation and hopefully this conference will allow us to share ideas to attack that problem.
Future of pediatric hepatology
The future is bright because the people who are in this field are curious and there are many challenges ahead, but as long as people are curious about why something is happening and are eager to try to get to that answer then the future is going to be bright.