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Published on: February 10, 2018
Liver transplantation in children
1Institute of Liver Studies, Department of Child Health King's College Hospital, Denmark Hill, London, England. mohamed.rela@kcl.ac.uk
Insights
Pediatric liver transplantation survival is near 90%, driven by surgical advances and improved immunosuppression. Future goals include reducing long-term immunosuppression needs in pediatric liver transplant recipients.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Immunology
Background:
- Liver transplantation outcomes in children have dramatically improved.
- One-year survival rates now approach 90% for pediatric chronic liver disease patients.
- Advances in surgical techniques, postoperative care, and immunosuppressive drugs are key drivers.
Purpose of the Study:
- To review the advancements in pediatric liver transplantation.
- To discuss the evolution of surgical strategies including reduced-size, split, and living donor liver transplantation.
- To highlight the impact of modern immunosuppression on graft survival and toxicity.
Main Methods:
- Review of surgical techniques and immunosuppressive strategies in pediatric liver transplantation.
- Analysis of survival data and complications.
- Discussion of evolving donor utilization and graft types.
Main Results:
- Significant improvements in one-year survival rates for pediatric liver transplant recipients.
- Development and refinement of techniques like reduced-size, split, and living donor liver transplantation.
- Reduced incidence of graft loss from chronic rejection and renal toxicity due to improved immunosuppressive management.
Conclusions:
- Pediatric liver transplantation is highly successful, with survival rates approaching 90%.
- Innovations in surgical approaches and immunosuppression have enhanced outcomes.
- Future research aims to minimize or eliminate the need for long-term immunosuppression in liver transplant recipients.
Abstract:
The results of liver transplantation has improved significantly in the last decade with one year survival figures close to 90% for children with chronic liver disease. This can be attributed to improvement in surgical techniques, better postoperative care and newer immunosuppresive drugs. As a result of this, increasing number of children are referred for transplantation with no significant increase in the number of solid organ donors. The earliest transplants in children were performed using organs from size matched pediatric donors. However, as the pediatric donor numbers were limited, liver reduction techniques were developed to transplant small children before deterioration. Increasing experience with reduced livers led to the development of split liver, living donor and auxiliary liver transplantation. Better management of immunosuppressive drugs and newer agents such as Mycophenolate Mofetil have reduced the incidence of graft loss due to chronic rejection and long-term renal toxicity. The goal for the future will remain to be transplantation without the use of long-term immunosuppression.
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