Valproic Acid-Associated Acute Liver Failure in Children: Case Report and Analysis of Liver Transplantation Outcomes in the United States

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• 作者：Ayse L. Mindikoglu ; Dale King ; Laurence S. Magder ; John A. Ozolek ; George V. Mazariegos ; Benjamin L. Shneider
• 刊名：The Journal of Pediatrics
• 出版年：2011
• 出版时间：May 2011
• 年：2011
• 卷：158
• 期：5
• 页码：802-807
• 全文大小：165 K

文摘

ss=""h4"">Objective

To determine whether valproic acid (VPA)-associated acute liver failure (ALF; VPA-ALF) explains the poor outcomes after liver transplantation (LT) in children.

ss=""h4"">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.

ss=""h4"">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.

ss=""h4"">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.