Published online Jun 18, 2015. doi: 10.4254/wjh.v7.i11.1509
Peer-review started: October 3, 2014
First decision: November 14, 2014
Revised: March 2, 2015
Accepted: March 18, 2015
Article in press: March 20, 2015
Published online: June 18, 2015
In 1953, the pioneer of human orthotopic liver transplantation (LT), Thomas E Starzl, was the first to attempt an orthotopic liver transplant into a 3 years old patient suffering from biliary atresia. Thus, the first LT in humans was attempted in a disease, which, up until today, remains the main indication for pediatric LT (pLT). During the last sixty years, refinements in diagnostics and surgical technique, the introduction of new immunosuppressive medications and improvements in perioperative pediatric care have established LT as routine procedure for childhood acute and chronic liver failure as well as inherited liver diseases. In contrast to adult recipients, pLT differs greatly in indications for LT, allocation practice, surgical technique, immunosuppression and post-operative life-long aftercare. Many aspects are focus of ongoing preclinical and clinical research. The present review gives an overview of current developments and the clinical outcome of pLT, with a focus on alternatives to full-size deceased-donor organ transplantation.
Core tip: As of today, pediatric liver transplantation (pLT) has become a safe and routine procedure for the treatment of childhood acute and chronic liver failure as well as inherited liver diseases. In contrast to adult recipients, pLT differs greatly in indications for LT, allocation practice, surgical technique, immunosuppression and post-operative life-long aftercare. Long-term survival after pLT implies life-long aftercare in an interdisciplinary team. The present review gives an insight into current indications for pLT, outcome after living-donor and deceased-donor organ transplantation and of ongoing clinical and preclinical developments to improve long-term outcome.