Skip to Main Content

++

Key Points

++

  1. Though liver transplantation remains a technically challenging operative procedure and patients are complex in their perioperative management, the use of whole organ, reduced size, split liver, and even living donors has resulted in an overall improved patient survival approaching 90% for infants and children alike. These techniques have also reduced waiting list mortality.

  2. The indications for liver transplantation have become somewhat more liberal and have improved outcomes for children with hepatoblastoma, a pediatric disease with a here-to-fore dismal prognosis.

  3. Improved immunosuppression includes multiple drugs and in some centers even steroid-free immunosuppression. These protocols have limited the adverse impact of allograft rejection while minimizing the complications of immunosuppression including infection and PTLD. Chronic rejection awaits a better solution.

++

Over the past 30 years, orthotopic liver transplantation (OLT) in the pediatric population has evolved from a heroic last ditch intervention to become the current standard of care. The pioneering development of surgical procedures such as reduced-size, living donor (LD), and split liver transplantation along with the evolution of immunosuppressive management has improved 1-year survival rates to more than 90%. Because short-term outcomes have improved so dramatically, attention is now focused on the long-term, optimizing quality of life and cognitive development.

++

Indications for Transplantation

++

Table 99-1 reviews primary diagnoses leading to pediatric transplantation. These disease entities define the bimodal age distribution of pediatric transplant recipients. Infants and children in the first few years of life represent patients with biliary atresia unresponsive to portoenterostomy, unresectable hepatoblastoma and, occasionally, rapidly progressive hepatic failure secondary to metabolic abnormalities such as neonatal tyrosinemia or neonatal hepatic vascular tumors. Older children and adolescents present with metabolic disturbances, fulminant liver failure, and cirrhosis from underlying chronic liver disease.

++
Table Graphic Jump Location
Table 99-1   Indications for Liver Transplantation at CCHMC from 2000 to 2010 
++

Biliary Atresia

++

Children with extrahepatic biliary atresia constitute at least 50% of the pediatric liver transplant population. Successful biliary drainage via Kasai portoenterostomy is the most important factor governing preservation of liver function ...

Want remote access to your institution's subscription?

Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.

Ok

About MyAccess

If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.

Subscription Options

AccessSurgery Full Site: One-Year Subscription

Connect to the full suite of AccessSurgery content and resources including more than 160 instructional videos, 16,000+ high-quality images, interactive board review, 20+ textbooks, and more.

$995 USD
Buy Now

Pay Per View: Timed Access to all of AccessSurgery

24 Hour Subscription $34.95

Buy Now

48 Hour Subscription $54.95

Buy Now

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.