Researchers Create App to Predict Whether Child in Acute Liver Failure Will Need Transplant


Children with a score of higher than 30 on the CHALF Score scale will need an emergency transplant.

In a new study conducted by Children’s Hospital Los Angeles (CHLA), researchers have developed a Children’s Hospital Los Angeles Acute Liver Failure (CHALF) Score that will help clinicians predict whether a child in acute liver failure will need a transplant or if they could recover.

 Doctor gastroenterologist making ultrasound examination of liver and pancreas to child in clinic closeup. Diagnosis and treatment of diseases of internal organs in children concep - Image credit: H_Ko |

Image credit: H_Ko |

Acute liver failure is defined as a rare condition in which the liver begins to lose ability to function.

The press release noted that each year in the United States, about 50 children are waitlisted to receive a transplant when in acute liver failure. Unlike conditions such as chronic liver disease, if a healthy child develops acute liver failure, their symptoms could quickly worsen. However, this progressive condition has no apparent trigger, other than a possible link to viral hepatitis and drug-induced liver injury. Researchers noted that when a child with acute liver failure is sent to the emergency room for care, health care officials only have a short amount of time to decide if the child needs a transplant.

“The liver has the potential to regenerate, unlike most other organs in the body,” said Juliet Emamaullee, MD, PhD, FRCSC, FACS, Children’s Hospital Los Angeles transplant surgeon, in a press release. “But you might not know whether a patient will become so sick that they need an emergency transplant—or if their liver has the potential to recover. A liver transplant is a major operation that commits them to lifelong immunosuppressant drugs, among other issues.”

Emamaullee led the group of researchers in creating the CHALF Score — a web-based application that can be downloaded on smartphones without charge.

The tool can help determine whether a child will need to be sent to a transplant center, as doctors do not want to refer a child for a liver transplant unless deemed absolutely necessary. The study authors noted that about 70% of children recover from acute liver failure with their original liver, but 25% of children need an emergency transplant. If the child becomes too sick before receiving the transplant or if they do not receive it in time, it could result in death—occurring in 10% to 15% of children in need of a new organ.

“We are always playing a guessing game,” said Rohit Kohli, MBBS, MS, Chief of the Division of Gastroenterology, Hepatology, and Nutrition at CHLA and study coauthor, in a press release. “And of course, for safety’s sake, we're on the side of trying to transfer and list the child [for transplant] as fast as possible. But many times, children will rally.”

The CHALF Score was created by generating a machine learning-based model and guiding it based on results found through 147 children in acute liver failure that were treated at CHLA.

The 147 children were categorized by demographics, diagnosis, and laboratory results that were taken when they were being treated. The researchers then used statistical methods to attain clinical tests and values to aid the prediction of the probability of the child surviving with or without a liver transplant.

After constructing the CHALF Score, the researchers included 492 children through the national Institutes of Health Pediatric Acute Liver Failure Study Group, that could predict outcomes at a high accuracy.

The study authors noted that the liver failure risk score through the CHALF Score app was on a scale of 5 to 60. If a score was higher than 30, the child would need an urgent liver transplant, and a score under 30 deemed that the child could survive with their original liver.

“Every time, the actual outcomes matched the CHALF prediction,” said Kohli, in a press release. “It's like a light in a very dark room. Teams in emergency rooms will be able to decide whether to transfer a child to a transplant center, and then whether to list a child for liver transplant. Both of those decisions will be helped by this tool.”


Children’s Hospital Los Angeles researchers develop clinical tool to predict if a child in acute liver failure will need a transplant. EurekAlert!. News release. October 24, 2023. Accessed November 3, 2023.

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