Liver Transplantation Reverses Hepatic Myelopathy in 2 Children With Hepatitis A Infection

Abstract

Objectives: To report 2 children with acute hepatic myelopathy after hepatitis A infection who recovered completely after living donor liver transplantation. Methods: All the children admitted into liver intensive care unit (LICU) from November 1st 2018 to 31st October 2019, were evaluated for the neurological features. The data was collected from the admission register of the LICU unit in children below 15 years age. Medical records of these children were reviewed and data collected. Established clinical criteria were used to categorize the various grades of hepatic encephalopathy/myelopathy. Results: 37 children were seen over 1-year period between 6 months to 15 years age. There were 24 male(64.9%) and 13 females. Acute liver failure was seen in 19 (51.3%) and acute on chronic liver failure in 18 (48.7%). There were 10 cases of hepatitis A in acute liver failure group,10 of 19 cases (52.6%), while Wilson’s disease and undetermined etiology group formed the chronic group. 2 cases of hepatic myelopathy were seen in acute liver failure following hepatitis A infection. Both these children underwent live liver donor transplantation and recovered completely. Further in hepatitis A group,3 children had spontaneous recovery, 4 died and 1 child was discharged with end of life care. Overall out of all 37 children with liver failure,20 (54%) were discharged, 6 (16.2%) were advised end of life care and 11 (29.8%) died. Conclusion: Two cases (10.5%) of reversible hepatic myelopathy were seen in acute liver failure group of 19 cases. 18 out of 37 (48.6%) children had residual neurological features at discharge time.

Eliminating viral hepatitis in children after liver transplants: How to reach the goal by 2030

“…Manifestations of hepatitis A virus (HAV) infection mainly derive from the immunologic responses to the virus and might present as severe acute liver failure in healthy children[ 1 ]. The incidence of fulminant hepatic failure from HAV infection varies from 0.1% to 1% but increases in patients with chronic liver disease[ 2 - 4 ].…”

Spontaneous remission of hepatic myelopathy in a patient with alcoholic cirrhosis: A case report

“…When comparing patients in whom HM was reversed after liver transplantation and patients whose HM was not reversed, it is generally recognized that the likelihood of HM reversal may be higher when liver transplantation is performed within 18 mo after the onset of symptomatic HM[ 4 ]. This theory was further verified by Koul et al ’s report, in which two children with acute HM after hepatitis A infection recovered completely after receiving donor liver transplantation[ 14 ].…”

Liver Transplantation Reverses Hepatic Myelopathy in the Decompensated Phase of Cirrhosis: Case Report and Literature Review

“…However, recovery is rapid and complete in spinal cord disease associated with acute liver failure because these patients have only demyelinating changes without axonal loss. 22 It cannot be ignored that while immunosuppressive regimens after LT have improved the survival of liver transplant recipients, the side effects of immunosuppressive agents pose a significant threat to postoperative quality of life and long-term prognosis. Calcineurin inhibitor-induced neurotoxicity is a common neurologic complication after LT, occurring in approximately 40% of liver transplant recipients, usually in the first month post-transplantation.…”

“…The patients' clinical characteristics and post-transplantation outcomes are shown in Table 1. 2,[7][8][9][13][14][15][16][17][18][19][20][21][22][23] The lack of standardized reporting parameters limited the summary analysis of the literature. However, our analysis led to the following conclusions (Table 2).…”