Pediatric Liver Transplantation: Selection Criteria and Post-transplant Medical Management

Overview

Journal Indian J Pediatr

Specialty Pediatrics

Date 2023 Dec 27

PMID 38150147

Authors

Sunitha Vimalesvaran

Anita Verma

Anil Dhawan

Affiliations

Soon will be listed here.

Abstract

Pediatric liver transplantation remains the gold standard for life-threatening acute and chronic liver diseases and multiple liver-based inherited metabolic defects. Advances in surgical techniques, better perioperative care and immunosuppression regimes have resulted in excellent long-term graft and patient survival. The success of pediatric liver transplantation does however bring the additional challenge of long-term patient outcomes including graft hepatitis-related fibrosis and suboptimal biopsychosocial outcomes. In this review, authors will explore the current landscape of pediatric liver transplantation including indications, timing of referral for liver transplantation, surgical techniques and long-term outcomes such as recurrence of pre-transplant liver disease, idiopathic graft hepatitis and biopsychosocial outcomes. Ultimately, early identification and management of potential issues long-term helps ensure our recipients achieve a "meaningful survival".

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Chronic Liver Disease in Children: From Diagnosis to Liver Transplantation.

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References

Vimalesvaran S, Souza L, Deheragoda M, Samyn M, Day J, Verma A . Outcomes of adults who received liver transplant as young children. EClinicalMedicine. 2021; 38:100987. PMC: 8413260. DOI: 10.1016/j.eclinm.2021.100987. View

Rela M, Reddy M . Pediatric Liver Transplantation: An Asymmetrical War for Access to Livers. Gastroenterology. 2017; 153(4):888-889. DOI: 10.1053/j.gastro.2017.08.054. View

Vimalesvaran S, Dhawan A . Liver transplantation for pediatric inherited metabolic liver diseases. World J Hepatol. 2021; 13(10):1351-1366. PMC: 8568579. DOI: 10.4254/wjh.v13.i10.1351. View

Freeman Jr R, Wiesner R, Roberts J, McDiarmid S, Dykstra D, Merion R . Improving liver allocation: MELD and PELD. Am J Transplant. 2004; 4 Suppl 9:114-31. DOI: 10.1111/j.1600-6135.2004.00403.x. View

Salvalaggio P, Neighbors K, Kelly S, Emerick K, Iyer K, Superina R . Regional variation and use of exception letters for cadaveric liver allocation in children with chronic liver disease. Am J Transplant. 2005; 5(8):1868-74. DOI: 10.1111/j.1600-6143.2005.00962.x. View

Duffy J, Kao K, Ko C, Farmer D, McDiarmid S, Hong J . Long-term patient outcome and quality of life after liver transplantation: analysis of 20-year survivors. Ann Surg. 2010; 252(4):652-61. DOI: 10.1097/SLA.0b013e3181f5f23a. View

Seda-Neto J, Antunes da Fonseca E, Pugliese R, Candido H, Benavides M, Afonso R . Twenty Years of Experience in Pediatric Living Donor Liver Transplantation: Focus on Hepatic Artery Reconstruction, Complications, and Outcomes. Transplantation. 2016; 100(5):1066-72. DOI: 10.1097/TP.0000000000001135. View

Horvat N, Marcelino A, Horvat J, Yamanari T, de Arimateia Batista Araujo-Filho J, Panizza P . Pediatric Liver Transplant: Techniques and Complications. Radiographics. 2017; 37(6):1612-1631. DOI: 10.1148/rg.2017170022. View

Chaubal G, Nanavati A, Biradar V, Tambe S, Hatimi H, Deshpande A . Monosegment Liver Allografts for Liver Transplantation in Infants Weighing Less Than 6 kg: An Initial Indian Experience. Transplant Proc. 2021; 53(5):1670-1673. DOI: 10.1016/j.transproceed.2021.01.005. View

10.

Quadros J, Piedade C, Lopes M . Auxiliary liver transplantation for management of acute liver failure in children - Systematic review. Transplant Rev (Orlando). 2021; 35(4):100631. DOI: 10.1016/j.trre.2021.100631. View

11.

Faraj W, Dar F, Bartlett A, Vilca Melendez H, Marangoni G, Mukherji D . Auxiliary liver transplantation for acute liver failure in children. Ann Surg. 2010; 251(2):351-6. DOI: 10.1097/SLA.0b013e3181bdfef6. View

12.

Weiner J, Griesemer A, Island E, Lobritto S, Martinez M, Selvaggi G . Longterm outcomes of auxiliary partial orthotopic liver transplantation in preadolescent children with fulminant hepatic failure. Liver Transpl. 2015; 22(4):485-94. DOI: 10.1002/lt.24361. View

13.

Kato T, Selvaggi G, Levi D, Hernandez E, Takahashi H, Velasco M . Routine use of auxiliary partial orthotopic liver transplantation for children with fulminant hepatic failure: Preliminary report. Transplant Proc. 2006; 38(10):3607-8. DOI: 10.1016/j.transproceed.2006.10.038. View

14.

Ciria R, Davila D, Heaton N . Auxiliary liver transplantation in children. Curr Opin Organ Transplant. 2011; 16(5):489-93. DOI: 10.1097/MOT.0b013e32834a94cf. View

15.

Oishi K, Arnon R, Wasserstein M, Diaz G . Liver transplantation for pediatric inherited metabolic disorders: Considerations for indications, complications, and perioperative management. Pediatr Transplant. 2016; 20(6):756-69. PMC: 5142218. DOI: 10.1111/petr.12741. View

16.

Neves D, Rusi M, Diaz L, Salvalaggio P . Primary graft dysfunction of the liver: definitions, diagnostic criteria and risk factors. Einstein (Sao Paulo). 2016; 14(4):567-572. DOI: 10.1590/S1679-45082016RW3585. View

17.

Uemura T, Randall H, Sanchez E, Ikegami T, Narasimhan G, McKenna G . Liver retransplantation for primary nonfunction: analysis of a 20-year single-center experience. Liver Transpl. 2007; 13(2):227-33. DOI: 10.1002/lt.20992. View

18.

Kutluturk K, Sahin T, Karakas S, Unal B, Gozukara Bag H, Akbulut S . Early Hepatic Artery Thrombosis After Pediatric Living Donor Liver Transplantation. Transplant Proc. 2019; 51(4):1162-1168. DOI: 10.1016/j.transproceed.2019.01.104. View

19.

Nishida S, Kato T, Levi D, Naveen M, Berney T, Thierry B . Effect of protocol Doppler ultrasonography and urgent revascularization on early hepatic artery thrombosis after pediatric liver transplantation. Arch Surg. 2002; 137(11):1279-83. DOI: 10.1001/archsurg.137.11.1279. View

20.

Nacoti M, Ruggeri G, Colombo G, Bonanomi E, Lussana F . Thrombosis prophylaxis in pediatric liver transplantation: A systematic review. World J Hepatol. 2018; 10(10):752-760. PMC: 6206147. DOI: 10.4254/wjh.v10.i10.752. View