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Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Pediatric liver transplantation: the Indian perspective
1Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi.
Insights
Pediatric liver transplantation offers over 85% long-term survival for end-stage liver disease, metabolic disorders, and liver cancer. Developing these vital services in India faces significant financial and societal challenges.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Liver transplantation is a standard treatment for end-stage liver disease, metabolic disorders, and liver cancer in children.
- Biliary atresia is the most frequent indication for pediatric liver transplants.
- Surgical innovations like liver reductions/splits and living-related transplants have improved outcomes and reduced waiting times.
Purpose of the Study:
- To highlight the success of pediatric liver transplantation globally.
- To identify barriers to establishing pediatric liver transplant programs in India.
- To advocate for the development of pediatric liver transplantation services in India.
Main Methods:
- Review of existing literature on pediatric liver transplantation outcomes.
- Analysis of factors impeding the establishment of transplant facilities in India.
- Discussion of essential components for successful transplant programs.
Main Results:
- Long-term survival rates for pediatric liver transplant recipients in Western countries exceed 85%.
- Established protocols exist for intensive care, anesthesia, and immunosuppression.
- Significant financial and societal barriers hinder progress in India.
Conclusions:
- Pediatric liver transplantation is a highly successful intervention with established protocols.
- Addressing cost, societal attitudes, and organizational issues is crucial for developing pediatric liver transplant programs in India.
- There is a critical need for accessible pediatric liver transplantation services for children in India.
Abstract:
Liver transplantation is now the accepted treatment for end stage liver disease, hepatic-based inborn errors of metabolism and localised primary hepatic malignancies. In children the commonest indication is biliary atresia. Innovations in surgical techniques, particularly liver reductions/splits and living related transplants have not only shortened the waiting period but have improved the results of surgery as well. The long term survival for pediatric liver transplant recipients in most large series from the Western world is more than 85%. Treatment protocols for ITU care of donors and recipients, anaesthetic care during surgery and post-operative immunosuppression are available. A country like India has a crying need for the development of facilities for liver transplantation in children but a number of factors have hampered the progress. The cost of surgery and post-operative immunosuppression and attitudes on life and death issues have been the greatest impediment. A few organisational details have also to be addressed to in order to minimise interdepartmental clashes of interest. It is hoped that a viable programme would soon be available for the children in India.
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