Pediatric liver transplantation

Liver transplantation is accepted therapy for acute or chronic liver failure. Advances in preoperative and postoperative management and surgical techniques have extended the indications for transplantation and refined selection, particularly for fulminant hepatic failure. Radiologic techniques, such as magnetic resonance imaging and placement of transjugular intrahepatic portosystemic shunts, have improved preoperative assessment and management. Successful split liver and living related transplantation may reduce waiting list deaths and relieve the organ donor shortage. Auxiliary liver transplantation, although technically difficult, is now accepted management for Crigler-Najjar type I disease but remains controversial for the treatment of organic acidemias and fulminant hepatic failure. Microsurgical techniques have reduced the incidence of postoperative hepatic thrombosis, and radiologic management of portal vein thrombosis and stenosis has decreased operative intervention and improved survival. Immunosuppressive drugs such as cyclosporine microemulsion and tacrolimus have the potential to improve rejection rates and reduce sepsis in the future. There are now good data confirming that long-term survival is achieved with nutritional rehabilitation and good quality of life.