Paediatric liver transplantation

Abstract

Liver transplantation is accepted as a life saving treatment for children with end stage liver disease. Until recently, treatment options for the debilitating effects of liver disease in children were limited to supportive therapy, anti-viral agents and immunosuppressive agents. With surgical conditions such as biliary atresia, some success has been achieved with timely diagnosis and early surgical intervention. However, in many cases even with expert management there was inevitable progression of liver disease. Liver transplantation offers the only chance of a cure for these unfortunate children. Although the first attempted human transplant was performed in 1963, it was not until 5 years later that long-term success was achieved. Advances in surgical technique, anaesthetic management, pre- and post-operative care and refi nements in immunosuppression over the last 4 decades have resulted in a much improved outcome and wide acceptance of liver transplantation among paediatricians with an everincreasing list of indications being identifi ed. The full story of liver transplantation for children is yet to be told but the current expected 5-year survival is now greater than 85% in major paediatric transplant centres. Excellent quality of life is the rule rather than the exception. The longest survivor is well more than 35 years after transplantation. Current anxieties are over organ donor scarcity, long-term side effects of the immunosuppressive therapy and some ethical issues. The focus of attention has now shifted from an initial target of early post-transplant survival to quality of life in the long-term. The transformation of a miserable jaundiced invalid into an active healthy child remains a powerful stimulant for paediatricians and transplant surgeons alike. © 2009 Springer Berlin Heidelberg.