Pediatric hepatology. A half-century of progress

Treating a pediatric patient offers a unique opportunity to develop effective strategies to prevent progressive liver injury and to develop novel therapeutic regimens to reduce the need for OLT. Universal vaccination against hepatitis viruses will prevent cirrhosis and liver cancer. Education and counseling may reduce the incidence of alcoholic liver disease. Precise and early screening for metabolic liver disease and genetic or targeted therapy may prevent disease progression. A retrospective look at the 1983 National Institutes of Health Consensus Conference on Liver Transplantation, after more than 15 years of experience among many centers, indicates that liver transplantation can be effectively used to childhood liver disease. Projections 10 years into the future offer hope that liver transplantation may not be needed in the treatment of certain diseases such as metabolic liver disease and fulminant hepatic failure. Focusing on prevention or treatment of liver disease in early life, thoughtful medical management, precise decision making, and conscientious, creative, and courageous use of nontransplant options, can save both livers and lives.