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Updated: Jun 21, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
[Pediatric liver transplantation]
Dominique Debray1, Olivier Bernard, Frédéric Gauthier
1Service d'hépatologie pédiatrique, Hôpital Bicêtre, AP-HP, Pôle adolescent-mère-enfant, Le Kremlin-Bicêtre Cedex, France.
Insights
Pediatric liver transplantation (LT) in children, often using partial grafts, faces complications like sepsis and EBV-related disease. Despite challenges, long-term survival is high, with most children achieving a good quality of life post-transplant.
Area of Science:
- Pediatric Hepatology
- Transplantation Surgery
- Immunology
Context:
- Liver transplantation (LT) in children under 16 represents 6-8% of annual LT procedures in France.
- Indications are primarily neonatal cholestatic diseases, with biliary atresia being the most common.
- Pediatric LT often involves partial liver grafts due to the recipients' young age (median 2 years).
Purpose:
- To review the indications, surgical considerations, and outcomes of pediatric liver transplantation.
- To identify specific complications and survival rates in pediatric LT recipients.
- To highlight long-term graft survival and quality of life in this population.
Summary:
- Pediatric LT commonly uses partial grafts, increasing risks of vascular and biliary complications compared to whole-liver transplants.
- Sepsis is a primary early cause of mortality.
- Specific complications in young children include EBV-related post-transplantation lymphoproliferative disease, food allergies (tacrolimus-related), and acquired renal cystic disease (cyclosporine-related).
Impact:
- Despite early complications, 10-year survival rates for pediatric LT exceed 70-80%.
- Health-related quality of life post-transplantation is generally close to normal.
- Late graft failure, primarily due to chronic rejection from immunosuppressant non-adherence, affects about 10% of children.
Abstract:
Liver transplantations (LT) performed in children aged younger than 16 years account for 6 to 8% of the total number of LT performed yearly in France. Indications for pediatric LT are mainly chronic cholestatic diseases of neonatal onset that lead to biliary cirrhosis; the most common is biliary atresia. Because most children are very young at transplantation (median age of 2 years), LT is performed in most cases with left lateral segments from a deceased donor or a related living donor. This increases the rate of postoperative vascular and biliary complications, compared with whole-liver transplantation. The principal early cause of death is sepsis. Some specific post-LT complications occur more frequently in young children than adolescents or adults: EBV-related post-transplantation lymphoproliferative disease and food allergies in young recipients treated with tacrolimus and acquired renal cystic disease, associated with renal dysfunction, mostly in children treated with cyclosporine. Despite the high rate of early post-LT complications, 10-year survival exceeds 70 to 80% and health-related quality of life is close to normal. Only about 10% of children will require a late retransplantation, mainly for chronic liver graft rejection, which most often results from poor or non-adherence to immunosuppressants, especially during adolescence.
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