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Pediatric Liver Transplantation

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Pediatric Surgery

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Abstract

Liver transplantation (LT) is standard care for children with end-stage, irreversible liver disease. In general, liver transplantation should be considered as a therapeutic option in all cases of acute and chronic liver disease before the end-stage liver disease is reached. The most common indications for pediatric liver transplantation are biliary atresia (43%), metabolic diseases (13%), and acute liver failure (11%). Liver transplantation offers the only chance of a cure for these children. However, timing of liver transplantation is crucial as this not only affects survival rate but may influence the long-term neurodevelopmental outcome. Many children with cirrhosis and portal hypertension have well-compensated liver function; thus the timing of liver transplantation may be difficult and is based on a gradual deterioration in hepatic function, failure of nutrition and growth, and difficulty in maintaining normal life and education. Liver transplantation is a curative treatment for end-stage liver stage with lifelong risk of morbidity and mortality. It is therefore important that a thorough evaluation (pretransplant assessment) of the child and family should consider suitability for this treatment.

The results of elective pediatric liver transplantation are now approaching 95% at 1 year, with 5-year survival rates of over 85%. Long-term morbidity is associated with complications from immunosuppression and chronic rejection. 10–15% of pediatric patients require re-transplantation due to graft failure. Outcome largely depends on the indication for re-transplantation and is quite good for technical causes but less satisfactory for rejection and infection. An increasingly poorer outcome can be expected after third and fourth re-transplants, and the efficacy and ethics of these interventions are in question. New and more varied immunosuppressive agents along with improved organ preservation and perioperative and postoperative care have been important advances in achieving these results. The success of liver transplantation in the management of children with liver disease has created new challenges with shortage of donor organs and an increasingly complex case mix for pediatric surgeons and hepatologists.

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Authors and Affiliations

  1. The Liver Unit, Birmingham Women’s & Children’s Hospital, Birmingham, UK

    Khalid Sharif

  2. Pediatric Hepatology, Birmingham Women’s & Children’s Hospital, University of Birmingham, Birmingham, UK

    Deirdre A. Kelly

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  1. Khalid Sharif
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  2. Deirdre A. Kelly
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Correspondence to Khalid Sharif .

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  1. Our Lady’s Children's Hospital, National Children’s Research Centre, Dublin, Ireland

    Prem Puri

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Sharif, K., Kelly, D.A. (2020). Pediatric Liver Transplantation. In: Puri, P. (eds) Pediatric Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38482-0_136-1

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  • DOI: https://doi.org/10.1007/978-3-642-38482-0_136-1

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