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Advances in pediatric liver and intestinal transplantation
R M Ghobrial1, D G Farmer, F Amersi
1University of California, Los Angeles, Medical Center, Los Angeles, California 90095, USA.
Insights
Pediatric liver and intestinal transplantation have advanced, with split-liver and living-related procedures significantly reducing wait times and improving survival for children needing transplants.
Area of Science:
- Pediatric surgery
- Organ transplantation
- Gastroenterology
Background:
- Pediatric liver and intestinal transplantation have seen significant advancements.
- Graft scarcity leads to high mortality rates in children awaiting transplantation.
- Innovations like split-liver and living-related liver transplantation maximize donor utilization.
Purpose of the Study:
- Review current indications and contraindications for pediatric liver and intestinal transplantation.
- Discuss surgical innovations to expand the donor liver pool.
- Evaluate postoperative management and its impact on patient and graft survival.
Main Methods:
- Review of current literature on pediatric liver and intestinal transplantation.
- Analysis of surgical innovations in graft utilization.
- Assessment of outcomes including patient and graft survival.
Main Results:
- Reduced-size liver grafts benefit pediatric recipients.
- Split-liver transplantation may reduce the need for other techniques except in urgent cases.
- Living-related and split-liver transplantation have decreased waiting periods and improved survival.
Conclusions:
- Liver transplantation offers durable, long-term survival for pediatric patients.
- Living-related and split-liver transplantation have dramatically improved pediatric transplant outcomes.
- Intestinal transplantation has progressed due to surgical, immunosuppressive, and complication management improvements.
Background:
Significant progress has been made with liver and intestinal transplantation in pediatric patients. Shortage of whole-organ cadaveric grafts has resulted in a high mortality rate for children awaiting transplantation. New surgical procedures such as split-liver transplantation and living-related liver transplantation have evolved over the last decade to maximize donor utilization in pediatric patients.
Methods:
In this article we review the current indications and contraindications for liver and intestinal transplantation in children, the surgical innovations to expand an exceedingly small cadaveric liver pool, postoperative management, and the impact on patient and graft survival.
Results:
Reduced-size liver transplantation provides children with much needed small grafts; however, split-liver transplantation may eliminate the need for reduced-size and living-related liver transplantation except in urgent situations.
Conclusion:
Liver transplantation is a durable procedure that provides excellent long-term survival. The use of living-related and split-liver transplantation has dramatically reduced the waiting periods for children and improved survival. In the past decade significant progress has been made with intestinal transplantation owing to improvements in surgical technique, immunosuppressive agents, and early identification and treatment of postoperative complications.