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Published on: August 17, 2022
Pediatric liver transplantation: where do we stand? Where we are going to?
Denis Devictor1, Pierre Tissieres,
1Department of Pediatrics, Neonatal and Pediatric Intensive Care Unit, APHP-Bicêtre Hospital, Paris 11-Sud University, 94275 Le Kremlin-Bicêtre, France.
Insights
Pediatric liver transplantation (LT) survival exceeds 80% due to improved management and techniques like split-LT. Addressing donor shortages and enhancing quality of life are key future focuses for pediatric liver transplant recipients.
Area of Science:
- Hepatology
- Transplantation Surgery
- Pediatric Medicine
Background:
- Pediatric liver transplantation (LT) demonstrates high success rates, with over 80% long-term survival.
- Advancements in pre-, peri-, and post-transplant care have significantly improved outcomes.
- New surgical techniques like split-liver transplantation (split-LT) and living donor LT have expanded eligibility to infants.
Purpose of the Study:
- To review the progress and current status of pediatric liver transplantation.
- To discuss strategies for overcoming donor organ scarcity.
- To highlight emerging therapeutic options and the focus on post-transplant quality of life.
Main Methods:
- Review of advancements in surgical techniques and immunosuppression (e.g., calcineurin inhibitors).
- Exploration of strategies to increase donor organ availability, including donation after cardiac death.
- Assessment of innovative approaches for acute liver failure and metabolic disorders, such as extracorporeal devices and hepatocyte transplantation.
Main Results:
- Long-term survival rates for pediatric liver transplantation are consistently above 80%.
- Significant improvements in patient outcomes are attributed to multidisciplinary care and surgical innovations.
- Emerging strategies show promise for expanding donor pools and managing complex pediatric liver conditions.
Conclusions:
- Pediatric liver transplantation is a highly successful therapy, with ongoing efforts to improve donor availability and recipient quality of life.
- Hepatocyte transplantation and extracorporeal devices offer potential alternatives for specific pediatric liver conditions.
- Future research should focus on optimizing long-term outcomes and psychosocial well-being in pediatric LT survivors.
Abstract:
Pediatric liver transplantation (LT) is one of the most successful solid organ transplants with long-term survival more than 80%. Many aspects have contributed to improve survival, especially advancements in pre-, peri- and post-transplant management. The development of new surgical techniques, such as split-LT and the introduction of living related LT, has extended LT to small infants. Progress in the last 30 years has also been characterized by the introduction of calcineurin inhibitors. One problem remains the lack of donors. Donation after cardiac death offers a new possibility to increase the pool of potential donors. In children with acute liver failure, increasing interest has centered on the possibility of providing temporary liver support based on extracorporeal devices or hepatocyte transplantation. Similarly, hepatocyte transplantation offers new perspective in children with metabolic failure. As long-term survival increases, attention has now focused on the quality of life achieved by children undergoing LT.
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