Living donor liver transplantation for acute liver failure in pediatric patients caused by the ingestion of fireworks containing yellow phosphorus

Abstract

Yellow phosphorus is a protoplasmic toxicant that targets the liver. The ingestion of fireworks containing yellow phosphorus,either by children who accidentally consume them or by adults who are attempting suicide, often results in death due toacute liver failure (ALF). We present the outcomes of 10 children who ingested fireworks containing yellow phosphorus.There were 6 boys and 4 girls, and their ages ranged from 21 to 60 months. One patient remained stable without liver com-plications and was discharged. Three patients died of hepatorenal failure and cardiovascular collapse, and living donor livertransplantation (LDLT) was performed for 6 patients. The patients had grade II or III encephalopathy, a mean alanine amino-transferase level of 1148.2 IU/L, a mean aspartate aminotransferase level of 1437.5 IU/L, a mean total bilirubin level of 6.9mg/dL, a mean international normalized ratio of 6.6, a mean Pediatric End-Stage Liver Disease score of 33.7, and a meanChild-Pugh score of 11.3. Postoperatively, 2 patients had persistent encephalopathy and died on the second or third postop-erative day, and 1 patient died of cardiac arrest on the first postoperative day despite a well-functioning graft. The other 3patients were still alive at a mean of 204 days. In conclusion, the ingestion of fireworks containing yellow phosphoruscauses ALF with a high mortality rate. When signs of irreversible ALF are detected, emergency LDLT should be consideredas a lifesaving procedure; however, if yellow phosphorus toxicity affects both the brain and the heart in addition to the liver,the mortality rate remains very high despite liver transplantation. Liver Transpl 17:1286-1291, 2011.VC2011 AASLD.