Pediatric liver transplantation

Abstract

Liver transplantation, which once was an experimental procedure of no practical interest, has become the preferred treatment for infants and children dying of almost all non-neoplastic end-stage liver diseases. Liver replacement is being provided by many well-trained teams on all of the continents, as is evident from the program today--the first international symposium on pediatric liver transplantation. I have been honored in giving the first paper in the process of introducing the remarkable work of a gifted younger generation of physicians and surgeons.

Fig. 1

Total experience with orthotopic liver transplantation of 170 patients from 1963 to 1979 (A) and of 720 patients from 1980 to 1986 (B). Note the slight survival advantage of the pediatric recipients in both eras. Case accrual in the CsA era was until August 31, 1986, and follow-ups were to October 31, 1986.

Fig. 2

Diseases in 720 patients that led to liver replacement during 1980 to 1986. Note that malignant tumors and chronic active hepatitis were not heavily represented in the children. These latter diagnoses have carried a bad posttransplant prognosis in adults because of a high rate of recurrence of the original disease.

Fig. 3

Five-year actuarial survival rates of pediatric recipients with the most frequent diagnoses who were treated in the CsA era.