title: "Current state and prospects in managing liver transplanted children".
abstract: Pediatric liver transplantation (LTx) has revolutionized life chances and perspectives of children with liver disease. Following rapid establishment of the therapeutic concept in the early years of pediatric transplant medicine, more aspects beyond plain survival become increasingly important. In addition to improving the short to medium-term survival rates, researchers are focusing on themes such as rehabilitation, adherence and quality of life, long-term graft fibrosis and dysfunction, as well as the consequences of long-term immunosuppression. Also, more protocol biopsy data are available to evaluate increasing graft fibrosis. To manage their conditions, patients will need access to highly experienced pediatric liver transplant centers where clinical research will examine modulators of renal disease, endocrine and cardiovascular comorbidity and the development of graft fibrosis and malignancies. Assessment and evaluation of health-related quality of life and factors which influence clinical tolerance, adherence and transition from child to adult care will also be investigated. The analysis of multi-national registry data and more than 40years of experience with large patient cohorts will provide important clues to treatment and will thus get increasing attention. In the future, longitudinal assessment of the outcome for pediatric LTx patients should include more functional aspects than plain survival rates or laboratory parameters.
authors.affiliation: Hannover Medical School, Paediatric Gastroenterology and Hepatology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
authors.forename: E D
authors.initials: ED
authors.lastname: Pfister
authors.affiliation: University Hospitals Geneva, Swiss Center for Liver Disease in Children, Geneva, Switzerland.
authors.forename: V A
authors.initials: VA
authors.lastname: McLin
authors.affiliation: La Paz University Hospital, Department of Pediatric Hepatology, Madrid, Spain.
authors.forename: L
authors.initials: L
authors.lastname: Hierro
authors.affiliation: King's College Hospital NHS Foundation Trust, Paediatric Gastrointestinal, Liver and Nutrition Centre, London, United Kingdom.
authors.forename: S A
authors.initials: SA
authors.lastname: Tizzard
authors.affiliation: Hannover Medical School, Paediatric Gastroenterology and Hepatology, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: Baumann.u@mh-hannover.de.
authors.forename: U
authors.initials: U
authors.lastname: Baumann
mesh_terms: D002648:Child; D006801:Humans; D007165:Immunosuppression Therapy; D016031:Liver Transplantation; D016896:Treatment Outcome