{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T23:17:38Z","timestamp":1787786258827,"version":"build-2784847793"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. pediatr. gastroenterol. nutr."],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Paediatric acute liver failure (PALF) and hepatitis of indeterminate aetiology with distinctive CD8+ T\u2010cell rich liver infiltrates is a recently recognised disorder of immune\u2010mediated dysregulation. We aimed to characterise the clinical phenotype, liver immunohistochemistry, response to immunosuppression (IS) therapy and clinical outcomes up to 24\u2010months in an Australian cohort.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Single\u2010centre retrospective study of patients aged 1\u201318 years who presented between 2017 and 2022 with hepatitis or acute liver failure with CD8+ rich infiltrates on liver biopsy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of the 13 patients identified, 8\/13 had CD8+\u2009PALF and 5\/13 had CD8+ hepatitis. Median age at presentation was 10.8 years (interquartile range [IQR] 7.8\u201312.3), and 85% were male. Peripheral lymphopenia was noted in 85% of patients. Corticosteroids (CS) were commenced in 10\/13 (77%) patients at a median of 13 days post\u2010illness\u2010onset (IQR 9\u201314). Maintenance IS was initiated in 7\/10 (70%) patients, at a median of 20 days post\u2010illness\u2010onset (IQR 19\u201337), with tacrolimus commenced in 4\/7 (57%) patients. At 24\u2010month follow\u2010up, 100% of patients were alive, 9\/13 (69%) survived with native liver (4\/8 with PALF; 5\/5 with hepatitis), 4\/8 (50%) with PALF required liver transplantation and 2\/13 (15%) developed aplastic anaemia and recovered without haematopoietic stem cell transplantation. Successful withdrawal of IS was achieved in 50% patients with their native liver.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Evaluation of liver immunohistochemistry and peripheral T\u2010cell subset analysis is essential for identification of patients with PALF and hepatitis with CD8+\u2009T\u2010cell predominant liver injury. Early CS and adjunct IS are safe and effective in achieving favourable outcomes at 24 months.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jpn3.70374","type":"journal-article","created":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T08:45:16Z","timestamp":1771231516000},"page":"1261-1268","source":"Crossref","is-referenced-by-count":1,"title":["Early immunosuppression therapy improves outcomes in CD8+ T\u2010cell activated paediatric acute liver failure and hepatitis"],"prefix":"10.1002","volume":"82","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8884-9636","authenticated-orcid":false,"given":"Prerna","family":"Diksha","sequence":"first","affiliation":[{"name":"Department of Gastroenterology and Clinical Nutrition Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winita","family":"Hardikar","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Clinical Nutrition Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Oliver","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Clinical Nutrition Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Yap","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Clinical Nutrition Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Hywood","sequence":"additional","affiliation":[{"name":"Department of Anatomical Pathology Royal Children's Hospital Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Alex","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology and Clinical Nutrition Royal Children's Hospital Melbourne Victoria Australia"},{"name":"Murdoch Children's Research Institute Melbourne Victoria Australia"},{"name":"Department of Paediatrics University of Melbourne  Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaun S. 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