Current developments in pediatric liver transplantation

Abstract

In 1953, the pioneer of human orthotopic liver transplantation (LT), Thomas E Starzl, was the first to attempt an orthotopic liver transplant into a 3 years old patient suffering from biliary atresia. Thus, the first LT in humans was attempted in a disease, which, up until today, remains the main indication for pediatric LT (pLT). During the last sixty years, refinements in diagnostics and surgical technique, the introduction of new immunosuppressive medications and improvements in perioperative pediatric care have established LT as routine procedure for childhood acute and chronic liver failure as well as inherited liver diseases. In contrast to adult recipients, pLT differs greatly in indications for LT, allocation practice, surgical technique, immunosuppression and post-operative life-long aftercare. Many aspects are focus of ongoing preclinical and clinical research. The present review gives an overview of current developments and the clinical outcome of pLT, with a focus on alternatives to full-size deceased-donor organ transplantation.

Keywords: Biliary atresia; Deceased organ donation; Living donor liver transplantation; Pediatric liver transplantation; Split liver transplantation.

Figure 1

Development of graft survival after pediatric liver transplantation from 1985 until 2013 (collaborative transplant study data). CTS: Collaborative transplant study; LT: Liver transplants.

Figure 2

Age distribution of pediatric liver transplantation recipients from 1985 until 2013 (collaborative transplant study data). CTS: Collaborative transplant study; LT: Liver transplants.

Figure 3

Outcome after pediatric liver transplantation in relation to the recipients age. A: Patient survival; B: Graft survival (collaborative transplant study data). CTS: Collaborative transplant study; LT: Liver transplants.

Figure 4

Donor age within the Eurotransplant network in 2013.

Figure 5

Relation of living (purple) vs deceased (blue) donors in pediatric liver transplantation from 1985 until 2013 (collaborative transplant study data). CTS: Collaborative transplant study; LT: Liver transplants.

Figure 6

Outcome after living vs deceased donor pediatric liver transplantation. A: Patient survival; B: Graft survival (collaborative transplant study data). CTS: Collaborative transplant study; LT: Liver transplants.

Figure 7

Outcome of liver transplantation in pediatric vs adult recipients. A: Patient survival; B: Graft survival (collaborative transplant study data). CTS: Collaborative transplant study; LT: Liver transplants.