[Fulminant hepatitis in children].

Viral hepatitis are one of the main causes of fulminant hepatic failure in children. Other causes of fulminant hepatic failure include metabolic diseases, especially in neonates and in infants, toxin-or drug-induced liver injury, hematologic and immune diseases. The spontaneous prognosis of fulminant hepatitis is poor with an overall mortality reaching 80%. The management of children with fulminant hepatic failure has been significantly transformed by emergency orthotopic liver transplantation. With this procedure, 1-year survival rates range from 55 to 80%. However, emergency liver transplantation still encounters serious problems including patient selection, organ availability, and the definition of optimum preoperative management of these patients. Several surgical innovations have been developed to resolve the shortage in liver grafts such as liver graft reduction or splitting for transplantation in two recipients. Because, spontaneous recovery remains unpredictable, new techniques are proposed such as the temporary orthotopic transplantation of auxiliary liver grafts, xenografts with monkey or pigs livers, hepatic assistance and bioartificial livers. These evolving strategies are currently under evaluation. Preventive treatment is one of the most effective approaches to fulminant hepatitis.