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41 - Liver Transplantation in Children

from SECTION V - OTHER CONDITIONS AND ISSUES IN PEDIATRIC HEPATOLOGY

Published online by Cambridge University Press:  18 December 2009

By
Greg Tiao M.D. ,
Maria H. Alonso M.D.  and
Frederick C. Ryckman M.D.
Edited by
Frederick J. Suchy ,
Ronald J. Sokol  and
William F. Balistreri
Greg Tiao M.D.
Affiliation:
Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Attending Surgeon, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Maria H. Alonso M.D.
Affiliation:
Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Associate Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Frederick C. Ryckman M.D.
Affiliation:
Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
Frederick J. Suchy
Affiliation:
Mount Sinai School of Medicine, New York
Ronald J. Sokol
Affiliation:
University of Colorado, Denver
William F. Balistreri
Affiliation:
University of Cincinnati
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Summary

Pediatric hepatologists and transplant surgeons have transformed the outcome of severe end-stage liver disease in children from hopelessness to success. Liver and combined multivisceral transplantation procedures have become the state-of-the-art treatment for these complex clinical problems, with anticipated success. The progressive improvement appreciated has been advanced through the use of innovative operative procedures using unique technical solutions in response to donor shortages. Although preoperative care advancements have significantly improved pretransplant morbidity, the full potential of improved transplant success has been limited by longer waiting lists and limited donor availability. Expanding indications for transplantation to children and adults with previously fatal diseases have increased this discrepancy. Parallel advances in critical care, immunosuppression, and postoperative management have also played a pivotal role in improved survival. However, the success of the past has bred unique problems that must be met in the future. If we are to succeed in meeting the needs of the increasing number of candidates, improved donor awareness and availability must occur. A delicate balance between the risks assumed by living donors and the needs of their children must be struck. The increasing numbers of surviving patients present unique challenges and complications related to lifelong immunosuppression. The future success of pediatric liver transplantation will require appreciation of the increasingly complex care needs of this population and a national focus on donor organ shortages.

THE SELECTION PROCESS

The primary aim of the evaluation process is to identify appropriate candidates for liver transplantation (LTx) and establish an effective pretransplant management plan.

Type
Chapter
Information
Liver Disease in Children , pp. 975 - 994
Publisher: Cambridge University Press
Print publication year: 2007

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  • Liver Transplantation in Children
    • By Greg Tiao, M.D., Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Attending Surgeon, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Maria H. Alonso, M.D., Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Associate Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Frederick C. Ryckman, M.D., Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
  • Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
  • Book: Liver Disease in Children
  • Online publication: 18 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547409.043
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  • Liver Transplantation in Children
    • By Greg Tiao, M.D., Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Attending Surgeon, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Maria H. Alonso, M.D., Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Associate Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Frederick C. Ryckman, M.D., Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
  • Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
  • Book: Liver Disease in Children
  • Online publication: 18 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547409.043
Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

  • Liver Transplantation in Children
    • By Greg Tiao, M.D., Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Attending Surgeon, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Maria H. Alonso, M.D., Assistant Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Associate Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, Frederick C. Ryckman, M.D., Professor, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio; Surgical Director, Liver Transplant Program, Department of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
  • Edited by Frederick J. Suchy, Mount Sinai School of Medicine, New York, Ronald J. Sokol, University of Colorado, Denver, William F. Balistreri, University of Cincinnati
  • Book: Liver Disease in Children
  • Online publication: 18 December 2009
  • Chapter DOI: https://doi.org/10.1017/CBO9780511547409.043
Available formats
×