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Pre-liver transplantation management of children
1Department of Paediatrics, National University of Singapore.
Insights
Pediatric liver transplantation offers an 80% survival rate for end-stage liver disease. Biliary atresia is the main reason, with portoenterostomy used initially due to donor organ scarcity.
Area of Science:
- Pediatric Gastroenterology and Hepatology
- Transplant Surgery
- Immunology
Background:
- Liver transplantation is a primary treatment for end-stage liver disease in children.
- Current five-year survival rates approach 80%.
- Biliary atresia is the most frequent indication for pediatric liver transplantation.
Purpose of the Study:
- To review the current status of liver transplantation in children.
- To highlight indications, contraindications, and management strategies.
- To discuss the challenges and outcomes of pediatric liver transplantation.
Main Methods:
- Review of current literature and clinical practices in pediatric liver transplantation.
- Analysis of indications, including biliary atresia.
- Discussion of contraindications, pre-operative assessment, and post-operative care.
Main Results:
- Liver transplantation achieves approximately 80% five-year survival in pediatric patients.
- Portoenterostomy serves as a bridge therapy for infants with biliary atresia due to donor organ shortage.
- Absolute contraindications include severe multi-organ disease and inadequate psychosocial support.
Conclusions:
- Liver transplantation is a viable and effective treatment for pediatric end-stage liver disease.
- Careful patient selection, pre-operative preparation, and post-operative management are crucial for success.
- Long-term immunotherapy is essential to prevent rejection and ensure graft survival.
Abstract:
Liver transplantation is the accepted treatment for children with end-staged liver diseases nowadays. Currently, the five year actuarial survival rate is about 80%. In children, the most common indication for transplantation is biliary atresia. Due to shortage of donor organs, portoenterostomy is still the initial treatment of choice for young infants with biliary atresia. This will enable the affected infants to continue growing until a suitable donor organ is available. There are a few absolute contraindications to liver transplantation in children. Severe irreversible disease in any other organs and poor psychosocial support are indications for not performing liver transplantation. Appropriate pre-operative assessment and preparations are necessary for a successful transplant. Post-operative course may be marred by rejection, infections and surgical complications. Long term immunotherapy is necessary.