In this World Shared Practice Forum podcast, Dr. Jeffrey Burns converses with experts Drs. Akash Deep, James Squires, and Barbara Wildhaber about pediatric acute liver failure and the intricacies of deciding when a child is unsuitable for liver transplantation. Discussing insights from their 2024 Lancet Child Health and Adolescent Health paper, they emphasize the importance of a multidisciplinary approach in evaluating clinical, biochemical, psychosocial, and ethical factors. The conversation highlights challenges with exclusion criteria, risks associated with severe multi-organ failure, and the necessity of balancing technical feasibility with overall patient prognosis, while also addressing the ethical implications of organ allocation.

LEARNING OBJECTIVES
- Identify key clinical and biochemical factors in evaluating pediatric liver transplant suitability
- Discuss the ethical and logistical considerations impacting transplant decisions in critically ill children with liver failure
- Summarize multidisciplinary approaches for determining when a child may be unsuitable for a liver transplant

AUTHORS
Akash Deep, MD, FRCPCH
Director - Paediatric Intensive Care Unit
and Staff Governor 
King's College Hospital, London 
Professor in Paediatric Critical Care
King's College London

James Squires, MD, MS
Associate Professor, Pediatrician
UPMC Children's Hospital of Pittsburgh

Barbara Wildhaber, MD
Professor
University Hospitals of Geneva
Chief Physician
Child and Adolescent Surgery
Swiss Pediatric Liver Center

Jeffrey Burns, MD, MPH
Emeritus Chief 
Division of Critical Care Medicine
Department of Anesthesiology, Critical Care and Pain Medicine 
Boston Children's Hospital
Professor of Anesthesia
Harvard Medical School

DATE
Initial publication date: February 25, 2025.

ARTICLE REFERENCED
Deep A, Alexander EC, Brierley J, Damian M, Gupta A, McLin V, Sarma MS, Squires JE, Wildhaber BE. Paediatric acute liver failure: a multidisciplinary perspective on when a critically ill child is unsuitable for liver transplantation. Lancet Child Adolesc Health. 2024 Dec;8(12):921-932. doi: 10.1016/S2352-4642(24)00255-4.

TRANSCRIPT
https://cdn.bfldr.com/D6LGWP8S/at/kn5r4s2wrnh3pm24gb9hkpvk/022025_WSP_Deep_Transplant_Challenges_in_Pediatric_Liver_Failure_Transcript.pdf

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CITATION
Deep A, Squires J, Wildhaber BE, Burns JP. Transplant Challenges in Pediatric Liver Failure. 02/2025. OPENPediatrics. Online Podcast: https://soundcloud.com/openpediatrics/transplant-challenges-in-pediatric-liver-failure-by-a-deep-et-al-openpediatrics.

Transplant Challenges in Pediatric Liver Failure by A. Deep et al. | OPENPediatrics

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