Chapter 26 - Pediatric liver transplantation

Summary

Liver transplantation (LT) is the accepted treatment for a wide variety of liver diseases in children. Some children develop hepatorenal or hepatopulmonary syndrome, which often reverses after LT. Acute liver failure (ALF) is rare in children, but is associated with significant mortality. Donor liver grafts for children are most commonly obtained from donation after brain death (DBD) donors. Split LT provides two grafts from a single donor, the left lateral segment for a child and the right lobe for an adult. Tacrolimus (TAC) is now the preferred agent for maintenance immunosuppression in pediatric LT. Immunosuppression generally requires the use of steroids, which are rapidly weaned or withdrawn in the majority of children. Common causes for retransplantation are hepatic artery thrombosis (HAT), primary graft dysfunction (PGD), chronic rejection and biliary complications. Health-related quality of life (HRQOL) assesses markers of overall well-being and functional outcomes, including physical, psychological, and social functions.