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Published on: May 7, 2015
Paediatric liver transplantation--a review based on 20 years of personal experience
1Unité de Chirurgie pédiatrique-Service de Transplantation Abdominale, Université Catholique de Louvain, Cliniques Saint-Luc, Avenue Hippocrate 10, 1200, Brussels, Belgium. otte@chex.ucl.ac.be
Insights
Pediatric liver transplantation offers over 90% long-term survival. Optimizing timing and donor selection, alongside advancements in immunosuppression for operational tolerance, are key for better outcomes in children with chronic liver disease.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Immunology
Background:
- Chronic liver diseases in children necessitate liver replacement, with established natural histories.
- Current pediatric liver transplantation achieves >90% long-term patient and graft survival.
- Anticipating transplantation timing minimizes the impact of chronic liver disease on children.
Purpose of the Study:
- To review the current state and future directions of pediatric liver transplantation.
- To highlight the importance of donor selection and immunosuppression strategies.
Main Methods:
- Review of existing literature on pediatric liver transplantation outcomes.
- Analysis of factors influencing patient and graft survival.
- Discussion of emerging immunosuppression protocols for operational tolerance.
Main Results:
- Grafts from younger donors are associated with superior long-term patient and graft survival.
- Live, related-donor transplantation is expected to increase due to donor shortages.
- Advancements in immunosuppression leveraging the liver's immunological privilege are anticipated.
Conclusions:
- Strategic timing and donor selection are crucial for successful pediatric liver transplantation.
- Future progress hinges on refining immunosuppression to induce operational tolerance.
- Continued development in live-donor protocols will address organ shortages.
Abstract:
The natural history of most liver diseases requiring liver replacement in children is well known, and the potential of this therapy has been ascertained regarding life expectancy, which currently exceeds 90% in the long term. The timing of liver transplantation must be anticipated, to reduce the physical, psychological and mental impact of chronic liver diseases. Several studies show evidence that the best long-term results with regard to patient and graft survival are obtained with grafts procured from relatively young donors. Since the shortage of post-mortem liver donors will most likely worsen, further development of live, related-donor transplantation can be expected. The main progress to come will concern immunosuppression, taking advantage of the immunological privilege of the liver. Protocols are under development for induction of operational tolerance.
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