Children's Hospital Colorado

Pediatric Acute Liver Failure

What is acute liver failure?

Acute liver failure (ALF) happens when the liver is no longer able to perform critical functions such as creating proteins, removing toxins from the blood and keeping blood sugar levels even.

Acute liver failure occurs when many cells in the liver die in a short period of time or the liver becomes damaged. Pediatric liver failure is not as common as liver failure in adults and liver failure in children is typically very rare.

What causes pediatric liver failure?

Acute liver failure in children can be linked to an infection, metabolic disease such as metabolic liver disease, drugs/medications and dysregulation of the immune system. About 50% of acute liver failure cases in children have no identified cause, according to several studies.

Acute liver failure in infants can be caused by:

  • Infections: Herpes simplex, echovirus, adenovirus, hepatitis B and parvovirus
  • Drugs or toxins: Acetaminophen
  • Cardiovascular conditions: Extracorporeal membrane oxygenation, hypoplastic left heart syndrome, shock, asphyxia, myocarditis
  • Metabolic disorders: Galactosemia, tyrosinemia, iron storage, mitochondrial condition, hereditary fructose intolerance (HFI) and fatty acid oxidation
  • Immune-related conditions: Autoimmune hepatitis, immune dysregulation, immune deficiency, hemophagocytic lymphohistiocytosis (HLH)

Acute liver failure in toddlers and older children can be caused by:

  • Infections: Hepatitis A, B and D, NANB hepatitis, Epstein-Barr virus, cytomegalovirus, herpes and leptospirosis
  • Drugs or toxins: Valproic acid, isoniazid, halothane, acetaminophen, mushroom, phosphorous and aspirin
  • Cardiovascular conditions: Myocarditis, heart surgery, cardiomyopathy, Budd-Chiari syndrome
  • Metabolic disorders: Fatty acid oxidation, Reye's syndrome, leukemia
  • Immune-related conditions: Autoimmune hepatitis, immune dysregulation, immune deficiency, hemophagocytic lymphohistiocytosis (HLH)

Who gets acute liver failure?

Acute liver failure can occur in children of all ages, from newborns to adolescents, and the causes vary widely.