Pediatric liver transplantation.
OBJECTIVE
Pediatric liver transplantation is a challenging and exciting field for all healthcare providers involved with children who have end-stage liver disease. Graft and patient survival continue to improve due to improvements in medical, surgical, and anesthetic management, organ availability, immunosuppression, and identification and treatment of postoperative complications. This review will describe recent advances in pediatric liver transplantation.


RESULTS
Although pediatric cases only represent approximately 10% of the total patients on the waiting list, the number of deaths on the waiting list increased from 196 to 1753 between 1988 and 1999. Recently, a new pediatric liver allocation policy was instituted. The utilization of cut down "reduced" livers, split liver grafts, and living-related donors has provided more organs for pediatric patients. Newer immunosuppression regimens, including induction therapy, continue to have a significant impact on graft and patient survival. Excellence in peri-operative management and identification and treatment of complications or infections also has had an impact on graft and patient survival. Finally, investigation and analysis of the postoperative quality of life, for both the patient and parents, is being conducted.


CONCLUSIONS
Pediatric liver transplantation is a challenging and rewarding field with continued improvements in patient and graft survival. A multidisciplinary team approach coupled with improvements in organ availability, immunosuppression, and peri-operative management has had a dramatic impact on survival.
Hendrickson
Richard J
RJ
Division of Pediatric Surgery, The Children's Hospital/The University of Colorado Health Sciences Center, Denver, 80218, USA. hendrickson.richard@tchden.org
Karrer
Frederick M
FM
Wachs
Michael E
ME
Slater
Kellee
K
Bak
Thomas E
TE
Kam
Igal
I
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D015276:Health Care Rationing / Q000379:methods; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016031:Liver Transplantation / Q000639:trends*; D018579:Patient Selection / Q000941:ethics; D011183:Postoperative Complications / Q000517:prevention & control / Q000628:therapy; D009927:Tissue and Organ Procurement / Q000639:trends