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Updated: Oct 6, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Paediatric liver transplantation: indications, timing and medical complications
K L Cox1, W E Berquist, R O Castillo
1Department of Pediatrics, Stanford University, California, USA. Kenneth.Cox@LPCH.Stanford.edu
Insights
Paediatric liver transplantation offers over 80% 5-year survival for end-stage liver disease. However, high mortality persists for infants and those with acute hepatic failure, with Epstein-Barr virus infection being a key post-transplant complication.
Area of Science:
- Pediatric Surgery
- Immunology
- Hepatology
Background:
- Paediatric liver transplantation has advanced significantly, achieving >80% 5-year survival for end-stage liver disease.
- Biliary atresia, metabolic diseases, and acute hepatic necrosis are primary indications for transplantation in children.
- The etiology of acute hepatic failure remains unknown in approximately 75% of pediatric cases.
Purpose of the Study:
- To review the current status and challenges of pediatric liver transplantation.
- To highlight factors influencing survival and neurodevelopmental outcomes.
- To identify key post-transplant complications and their impact.
Main Methods:
- Review of current surgical techniques and immunosuppressive therapies.
- Analysis of indications, donor types, and survival rates.
- Examination of pre- and post-transplant mortality and morbidity factors.
Main Results:
- Survival rates exceed 80% for pediatric liver transplants.
- Donor options have expanded, reducing waiting list mortality.
- High mortality/morbidity persists for infants (<5 months) and those with fulminant hepatic failure.
Conclusions:
- While survival has improved, significant challenges remain for high-risk pediatric liver transplant recipients.
- Rejection and infection are primary post-transplant complications.
- Epstein-Barr virus infection is a major cause of morbidity and mortality beyond 3 months post-transplant.
Abstract:
Newer surgical techniques and immunosuppressive therapies have resulted in paediatric liver transplantation being available for most children with end-stage liver disease and has resulted in a greater than 80% 5-year survival rate. The most common indications for paediatric liver transplantation are biliary atresia (43%), metabolic disease (13%) and acute hepatic necrosis (11%). For approximately 75% of children with acute hepatic failure, the cause is unknown. Timing of liver transplantation not only affects survival rate, but may influence neurodevelopmental outcome. Fortunately, numerous types of donors, such as reduced-sized, living related or unrelated and blood-type mismatched, have reduced the mortality of children who are waiting for liver transplantation. However, the mortality and morbidity before and after liver transplantation remain high for children who have fulminant hepatic failure or are less than 5 months of age at the time of transplantation. The principle medical complications after liver transplantation are rejection and infection. Although use of newer immunosuppressive regimens has reduced the rate of rejection, Epstein-Barr virus infection with associated lymphoproliferative disorder remains the principle cause for morbidity and mortality after the initial 3 months post-liver transplant.
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