Liver Failure

What is liver failure?

Liver failure is the severe decline of liver function. It is an uncommon but serious condition that occurs when the liver is impaired and can no longer perform important tasks like clearing toxins from the blood or producing bile, a substance that helps digest food.

Liver failure can affect infants, toddlers, older children, and adolescents.

There are two kinds of liver failure: acute liver failure and chronic liver failure.

Acute liver failure, also called fulminant hepatic failure, is the rapid loss of liver function over the course of days or weeks in a child who has no previous history of liver disease. Acute liver failure is a medical emergency that requires immediate medical attention.

The most common cause of acute liver failure in children is a toxin or virus that damages the liver.

Chronic liver failure, also known as end-stage liver disease, develops over a period of months or years as the result of damage caused by long-term liver disease such as biliary atresia, metabolic liver disease, hepatitis B or hepatitis C, or cirrhosis.

Without medical attention, a child with liver failure will become confused and disoriented, a condition known as encephalopathy.

Most children with acute or chronic liver failure will need a liver transplant. In a small number of cases of liver failure, 15 percent to 20 percent, the liver repairs itself spontaneously.

What is the liver, and what does it do?

The liver is the second largest organ in the body. Located in the abdominal cavity, the liver helps the body in many ways.

The liver:

  • produces proteins that allow blood to clot normally, transport oxygen, and support the immune system
  • produces bile, a substance that helps digest food
  • stores extra nutrients
  • helps clean the bloodstream of harmful substances
  • helps control blood sugar and cholesterol levels

How we care for liver failure

The Center for Childhood Liver Disease at Boston Children’s Hospital specializes in helping infants, children, adolescents, and young adults with a wide variety of liver, gallbladder, and bile duct disorders. Our services include the most up-to-date technology to make an accurate diagnosis and comprehensive treatment plan. Doctors refer children with liver disease to Boston Children’s from all over the world.

Our areas of innovation in liver transplant

Since 1984, specialists in our Liver Transplant Program have performed more than 200 liver transplants. We offer expertise in whole-organ transplants, reduced-size liver transplants, split liver transplants, and related living-donor transplants.

Avoiding liver transplant for patients with metabolic disorders and liver tumors

Boston Children’s Hospital surgeon Khashayar Vakili, MD, specializes in liver, kidney, and intestinal transplant surgeries, while in the lab he is doing work which, for some patients, could eliminate the need for a transplant surgeon altogether.

One of his most promising research projects involves autologous hepatocyte transplantation — transplanting not the liver but only the liver cells, and doing so using cells from the patient to avoid the need for immunosuppression. Although the project is in its early stages, the potential implications are promising.

Eliminating waitlist mortality for children

Infants and young children have the highest risk of death on the liver transplant waiting list, mainly due to the shortage of appropriately sized organs. But Heung Bae Kim, MD, director of Boston Children’s Pediatric Transplant Center, has been researching ways to change that statistic.

Kim led a team of Boston Children’s researchers who examined pediatric data mortality and graft survival rates of patients under the age of 2 who received liver transplants. Published online in Liver Transplantation, a journal of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society, the data suggested that both split and whole organs had similarly low rates of both graft failure and mortality, suggesting that their use could be increased to meet the demand for smaller grafts.

Promoting liver cell regeneration to reduce the need for liver transplant

In addition, researcher Fernando Camargo, PhD, is investigating the different processes that promote liver regeneration and healing. This research could someday help reduce the number of children with liver failure who need a liver transplant.