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Liver transplantation in children: past, present and future
C Le Coultre1, G Mentha, D C Belli
1Clinique Chirurgie Pédiatrique, Hôpital des Enfants, Hôpital Universitaire Genève, Faculté de Médecine Genève, Suisse.
Insights
Pediatric liver transplantation offers over 80% survival for children with end-stage liver disease. Advances include reduced and split livers, improving organ availability and patient outcomes.
Area of Science:
- Hepatology
- Pediatric Surgery
- Transplantation Medicine
Background:
- Significant advancements in liver transplantation over two decades enable treatment for infants and children with end-stage liver disease.
- Key pediatric indications include congenital biliary obstructions, metabolic disorders causing cirrhosis, and fulminant hepatitis.
- Organ donor shortage is a challenge, partially addressed by reduced, split, and living-related donor liver grafts.
Purpose of the Study:
- To review the progress and outcomes of pediatric liver transplantation.
- To discuss indications, donor organ strategies, and survival rates in pediatric liver recipients.
- To explore future directions in liver transplantation, including alternative therapies and organ replacement technologies.
Main Methods:
- Review of pediatric liver transplantation cases and outcomes.
- Analysis of indications, donor organ utilization (reduced, split, living-related), and survival rates.
- Discussion of acute rejection management and long-term patient follow-up, including growth and liver function.
Main Results:
- Overall survival in pediatric liver transplantation exceeds 80%.
- A specific center reported an 86% survival rate in 15 pediatric patients over 6 years.
- Acute rejection was common but effectively managed with steroid boluses; long-term follow-up showed satisfactory growth and normal liver function.
Conclusions:
- Pediatric liver transplantation provides a life-saving option with high survival rates.
- Strategies like reduced-size and split grafts have improved organ availability.
- Future research focuses on reducing whole organ transplantation necessity through alternative therapies and bioengineered solutions.
Abstract:
The tremendous progress accomplished during the last twenty years in liver transplantation has permitted the treatment of infants and children who can now benefit from a new organ before an and stage liver disease. The main indications in paediatrics are congenital biliary obstructions, metabolic disorders leading to cirrhosis and fulminant hepatitis. Nevertheless, in the future, other treatments for metabolic and viral diseases will be possible. The shortage of paediatric donors has been partially alleviated by the method of reduced liver, however the general shortage of organs has led to the use of split livers and living-related donors. Overall survival in children can be expected above 80%. In Geneva, 15 paediatric patients were transplanted, 3 twice, over a 6-year period with a survival rate of 86%. The indications were the same as in other centers. Acute rejection was often noted, but easily treated, mainly by steroid bolus. 13 patients have been followed up for more than 1 year and have had satisfactory growth and normal liver function tests. Whenever a liver transplantation is performed, paediatricians have hopes and fears; hope of an improvement of growth and neuro-psychological developments and fears of side effects of immunosuppressive drugs, such as renal function impairment or lymphoproliferative syndrome. The future in the field of liver transplantation will require new methods, with the aim of decreasing the necessity of whole organ transplantation. This includes alternative treatments for metabolic disorders, transplantation of isolated hepatocytes, possibly after gene therapy, and the use of an artificial liver. Some of this future is already present.