Pediatric Acute Liver Failure: A Clinicopathological Perspective

Pediatr Dev Pathol. 2022 Jul-Aug;25(4):361-379. doi: 10.1177/10935266211067893. Epub 2022 Mar 31.


Pediatric acute liver failure (PALF) is a life-threatening disorder characterized by acute hepatocellular injury occurring in children without recognized underlying liver disease. The clinicopathologic evaluation of PALF requires a different approach from that in adults. The diagnostic considerations differ depending on the age, personal and family history, geographical region, and clinical presentation. Distinct entities such as gestational alloimmune liver disease, herpes simplex virus infection, and metabolic disorders should be considered in neonates with acute liver failure, while acetaminophen toxicity and autoimmune hepatitis are more frequently seen in older children and adolescents. An identified cause for PALF despite a negative complete evaluation (indeterminate) is lacking in 30 to 50% of cases. Although not routinely performed in the setting of PALF, liver biopsy may be helpful in assessing the etiology, potential mechanisms of injury, determining the appropriateness of liver transplantation, and prognostication of the patients. In this article, we review the clinicopathologic characteristics of PALF with an emphasis on general approach of pathologic evaluation and histopathologic characteristic of selected entities.

Keywords: acute hepatitis; fulminant hepatic failure; massive hepatic necrosis; metabolic disorders; pediatric acute liver failure.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Child
  • Humans
  • Infant, Newborn
  • Liver Failure, Acute* / pathology
  • Liver Failure, Acute* / therapy
  • Liver Transplantation