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Indications for pediatric liver transplantation
S V McDiarmid1, M J Millis, K M Olthoff
1Pediatric Liver Transplantation, UCLA Medical Center, Los Angeles, California 90095-1752, USA.
Insights
This review outlines pediatric orthotopic liver transplantation (OLT) indications and timing. It details diseases, contraindications, and crucial factors like malnutrition for listing children for OLT.
Area of Science:
- Pediatric Hepatology
- Transplantation Medicine
- Gastroenterology
Background:
- Orthotopic liver transplantation (OLT) is a critical treatment for end-stage liver disease in children.
- Accurate assessment of disease progression and patient condition is vital for successful transplantation outcomes.
- Understanding specific pediatric liver diseases and their management is essential for timely intervention.
Purpose of the Study:
- To review indications for pediatric orthotopic liver transplantation (OLT).
- To provide guidelines on the optimal timing for listing children for OLT.
- To discuss contraindications and factors influencing transplant decisions in pediatric patients.
Main Methods:
- Review of current literature on pediatric liver transplantation.
- Categorization of diseases requiring OLT in children.
- Analysis of natural history, pre-transplant therapies, and contraindications.
- Evaluation of clinical criteria, including malnutrition and extrahepatic disease, for transplant listing.
Main Results:
- Diseases necessitating OLT in children are categorized, with emphasis on pre-transplant care.
- Specific contraindications, particularly for metabolic disorders with extrahepatic involvement, are detailed.
- Malnutrition and poor development are highlighted as critical listing criteria.
- Timing considerations for pediatric-specific conditions like urea cycle defects are emphasized.
Conclusions:
- Appropriate timing and patient selection are paramount for successful pediatric OLT.
- Comprehensive evaluation of disease, patient status, and co-existing conditions informs listing decisions.
- This review offers essential guidance for clinicians managing pediatric liver disease and considering transplantation.
Abstract:
This review discusses the indications for orthotopic liver transplantation (OLT) in children and provides guidelines for the appropriate time to list children for transplant. The diseases for which OLT are indicated in children are divided into diagnostic categories with a focus on the natural history and appropriate medical and surgical therapy prior to transplantation. Contraindications to transplantation pertinent to specific diseases are outlined, with particular emphasis on complex metabolic defects with extrahepatic manifestations. The clinical conditions which indicate that listing for OLT is appropriate, as well as the relative and absolute contraindications, irrespective of diagnosis, are discussed. The importance of malnutrition and poor development as listing criteria is stressed. Special timing considerations for diagnoses relevant to the pediatric age group, e.g. urea cycle defects and Crigler-Najjar syndrome, are emphasized. Finally, the impact of co-existing extrahepatic disease on the decision to list children for OLT is reviewed.