J Pediatr Gastroenterol Nutr 1998 Aug;27(2):214-21

Current results and evolving indications for liver transplantation in children

Kelly DA
Birmingham Children's Hospital NHS Trust, United Kingdom.

Abstract
Liver transplantation continues to be successful and effective treatment for
acute and chronic liver failure, and many important lessons have been learned.
The development of innovative operative techniques has much reduced the waiting
list mortality rate and has extended transplantation to younger and sicker
children and to those with functionally normal livers who may benefit from
auxiliary liver transplantation. The incidence and range of postoperative
complications have improved with increased medical and surgical expertise. As
information on long-term outcome for liver transplantation is gained, it is
clear that many children will benefit from early elective liver transplantation
before the development of significant growth or psychosocial retardation. Early
transplantation is also indicated in children with cirrhosis and intrapulmonary
shunting or cystic fibrosis with moderate lung disease. During the same period,
evolving medical therapy has altered the natural history, patient selection, and
timing of transplantation in children with tyrosinaemia type I, primary bile
acid disorders, neonatal haemochromatosis, and potentially, cystic fibrosis. It
is now clear that children with significant multisystem disease, such as
mitochondrial disorders or severe systemic oxalosis, are no longer suitable
candidates for liver transplantation. The successful development of liver
transplantation has brought good quality life to many children and their
families. There are still many lessons to learn and there are future challenges
such as the ever-increasing problems of donor scarcity and the search for potent
but less toxic immunosuppressive agent