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Liver transplantations (LT) performed in children aged younger than 16 years account for 6 to 8% of the total number of LT performed yearly in France. Indications for pediatric LT are mainly chronic cholestatic diseases of neonatal onset that lead to biliary cirrhosis; the most common is biliary atresia. Because most children are very young at transplantation (median age of 2 years), LT is performed in most cases with left lateral segments from a deceased donor or a related living donor. This increases the rate of postoperative vascular and biliary complications, compared with whole-liver transplantation. The principal early cause of death is sepsis. Some specific post-LT complications occur more frequently in young children than adolescents or adults: EBV-related post-transplantation lymphoproliferative disease and food allergies in young recipients treated with tacrolimus and acquired renal cystic disease, associated with renal dysfunction, mostly in children treated with cyclosporine. Despite the high rate of early post-LT complications, 10-year survival exceeds 70 to 80% and health-related quality of life is close to normal. Only about 10% of children will require a late retransplantation, mainly for chronic liver graft rejection, which most often results from poor or non-adherence to immunosuppressants, especially during adolescence.

Viral hepatitis are the leading cause of fulminant hepatitis. Epstein Barr virus is the viral agent involved in infectious mononucleosis, associated with a frequent and usually benign hepatitis, except in case of immunodeficiency, congenital or acquired. We report the case of an immunocompetent young woman who presented an EBV induced fulminant hepatic failure, requiring liver transplantation that was successful. This observation emphasizes that EBV must be known as a possible cause of fulminant hepatitis and that liver transplantation is probably the unique therapeutic option to avoid a usually fatal course.

Liver transplantation is a medico-surgical treatment for patients with acute and chronic liver failure. In France, in 2005, 1024 liver transplantations have been performed, while in the same year 1691 patients were on the waiting list. Because of severe organ shortage, different approaches have been used as potential means to increase the availability of liver grafts (living donor, split, marginal grafts, non heart beating donor). In France, in 2007, the system of allocation organ will change (using a system similar to the MELD score) to prioritize patients with the highest risk of death while waiting for liver transplant.

Brain oedema leading to intracranial hypertension occurs in a significant proportion of patients with acute liver failure in whom it is a leading cause of death. Although precise pathogenic mechanisms associated to this severe complication remain incompletely understood, increasing evidence points to gut-derived neurotoxins including ammonia as key mediators in cerebral osmotic and perfusion disturbances. The management of brain oedema and intracranial hypertension requires a multidisciplinar approach in a center where liver transplantation is available, as this option is the only treatment modality that provides improvement in outcome. This article reviews the most common causes of acute liver failure and the standard of supportive care management, and describes future potential therapeutic aspects of brain oedema and intracranial hypertension.

The aim of this study was to develop in rats, a model of acute hepatic failure that mimics human fulminant hepatitis and to study the effect on survival of transplantation of isolated hepatocytes. This study showed that the mortality after 90% hepatectomy was reduced by the sole correction of hypoglycemia. On the other hand, 95% hepatectomy appeared as a reliable and reproductable model, associated with a period of hepatic coma, a deep disorder of coagulation, and a high mortality rate (> 80%) despite correction of hypoglycemia. In this model of acute hepatic failure, intraperitoneal transplantation of encapsulated isolated hepatocytes significantly reduced the mortality rate from 80% in the control groups to 31% in the transplanted group. A complete regeneration of the native liver was observed in all rats surviving. All animals survived after explantation of the hollow fibers. Well preserved hepatocytes were observed in hollow fibers two months after transplantation.