title: Pediatric liver transplantation: a North American perspective.
abstract: Liver transplantation (LT) is an important component in the therapeutic armamentarium of managing end-stage liver disease. In North American children, biliary atresia remains the most common indication for LT compared to hepatitis C in adults, while hepatoblastoma is the most common liver tumor requiring LT, versus Hepatocellular carcinoma in adults. Rejection, lymphoproliferative disease, renal insufficiency, metabolic syndrome, recurrent disease, 'de novo' autoimmune hepatitis and malignancy require careful surveillance and prompt action in adults and children after LT. In children, specific attention to EBV viremia, growth, development, adherence and transition to the adult services is also required. Antibody mediated rejection and screening for donor specific antibodies is becoming important in managing liver graft dysfunction. Biomarkers to identify and predict tolerance are being developed. Machine perfusion and stem cells (iPS) to synthesize organs are generating interest and are a focus for research.
authors.affiliation: a Keck School of Medicine, Medical Director Liver/Intestinal and Hepatology Transplant Program, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA.
authors.forename: Nanda
authors.initials: N
authors.lastname: Kerkar
authors.affiliation: b Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Los Angeles , University of Southern California , Los Angeles , CA , USA.
authors.forename: Arathi
authors.initials: A
authors.lastname: Lakhole
mesh_terms: D000367:Age Factors; D046148:Donor Selection; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005762:Gastroenterology / Q000379:methods*; D006084:Graft Rejection / Q000276:immunology / Q000517:prevention & control; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods*; D009656:North America; D010372:Pediatrics / Q000379:methods*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Children; biomarkers; machine perfusion; organ allocation; outcomes