Paediatric liver transplantation in Italy

The paediatric liver transplantation programme was started, at our institution, in 1988 and since then 75 children have received 79 transplants, which corresponds to about 85% of all the paediatric liver transplantations performed in Italy. The main indications to transplantation were biliary atresia, familiar cholangiopathies and metabolic diseases. The patients came from all the regions of Italy, except for 2 of them who came from abroad. Patients with malnutrition and impaired growth underwent an aggressive nutritional programme whilst waiting for transplantation. The transplants were performed using whole grafts, reduced size grafts and, recently, with grafts from split livers, in 7 cases. Immunosuppression was based on a double drug therapy with Cyclosporine and low dose steroids. Steroid resistant acute rejection was treated, with OKT3 until 1993 and with conversion from Cyclosporine to FK506, thereafter. Interventional radiology was most useful in treating biliary complications. The introduction of Gancyclovir greatly reduced the incidence and severity of cytomegavirus related complications. Three years survival after liver transplantation was 62% for children under 2 years of age and 78% for those between 2 and 15 years. These results do not differ substantially from those reported by the European Liver Transplant Registry.