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Indications for pediatric liver transplantation. Data from the Heidelberg pediatric liver transplantation program
1University of Heidelberg, Department of Paediatrics, INF 150, D-69120 Heidelberg, Germany. guido_engelmann@med.uni-heidelberg.de
Insights
Pediatric liver transplantation offers excellent survival rates for children with end-stage liver disease, driven by advancements in surgical techniques and immunosuppression. Biliary atresia is the leading indication for these life-saving procedures in young patients.
Area of Science:
- Pediatric Hepatology
- Organ Transplantation
- Pediatric Surgery
Background:
- Liver transplantation is a well-established treatment for pediatric end-stage liver disease, achieving high survival rates.
- Improvements in surgical techniques, immunosuppressive drugs, and clinical management have significantly enhanced outcomes.
- Key indications include acute liver failure (ALF), chronic liver failure with complications, and failure to thrive.
Purpose of the Study:
- To review the indications and outcomes of pediatric liver transplantation.
- To highlight the role of biliary atresia as the primary indication in children.
- To present data from a specific pediatric liver transplantation program.
Main Methods:
- Review of patient data from a pediatric liver transplantation program established in 2003.
- Analysis of indications for transplantation, including acute liver failure and biliary atresia.
- Evaluation of patient outcomes, considering prognostic factors like PELD score.
Main Results:
- Biliary atresia accounts for at least 50% of pediatric liver transplants.
- Prognostic models like the Pediatric End-Stage Liver Disease (PELD) score are crucial for assessing outcomes.
- The Heidelberg program has transplanted 15 children aged 5 months to 14 years.
Conclusions:
- Pediatric liver transplantation is a successful treatment for end-stage liver disease in children.
- Biliary atresia remains the most common indication, necessitating specialized care.
- Continuous advancements in the field are vital for improving patient survival and quality of life.
Abstract:
Nowadays liver transplantation is an established treatment for children with end-stage liver disease with very good 1- and 5-year survival. This has been achieved through constant improvement of surgical techniques, new immunosuppressive drugs and clinical management. Indications for liver transplantation in infants and children include acute liver failure (ALF), chronic liver failure with pruritus, complications of cholestasis and failure to thrive. In young children, the most common liver disease leading to transplantation is biliary atresia. Biliary atresia accounts for at least 50 percent of all liver transplants in children and is characterized by the failure of the bile ducts to develop normally and drain bile from the liver. Several models to assess prognosis of liver disease have been developed. In acute liver failure leukocyte count, bilirubin, International Normalized Ratio (INR) and age have a strong correlation with outcome. In chronic liver failure, PELD (Pediatric end-stage liver disease) Score and the occurrence of complications of liver disease are important prognostic tools. Since the start of our own paediatric liver transplantation program at the University of Heidelberg in 2003, already 15 Children between 5 months and 14 years have been transplanted. Indications and outcome of these patients are reviewed in this paper.
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