Fourteen children with acute viral hepatitis and hepatic coma were treated by conservative methods (low-protein diet, corticosteroids, neomycin sulfate) and exchange transfusion. Eleven patients were in grade 4 of hepatic coma, the other three in grade 3. The clinical and laboratory data presented by these patients before the exchange transfusion are analyzed. Seven patients survived which amounts to 50% of the group. A long-term follow-up study of six of them showed normal liver function and, in four, normal histological appearance of the liver by biopsy.