Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-6bf8c574d5-w79xw Total loading time: 0 Render date: 2025-03-01T06:30:44.412Z Has data issue: false hasContentIssue false

Chapter 43 - Liver transplantation in children: indications and surgical aspects

from Section V - Other considerations and issues in pediatric hepatology

Published online by Cambridge University Press:  05 March 2014

By
M. Kyle Jensen ,
Maria H. Alonso ,
Jaimie D. Nathan ,
Frederick C. Ryckman ,
Gregory M. Tiao  and
William F. Balistreri
Edited by
Frederick J. Suchy ,
Ronald J. Sokol  and
William F. Balistreri
M. Kyle Jensen
Affiliation:
University of Utah, Primary Children’s Medical Center, Salt Lake City, UT, USA
Maria H. Alonso
Affiliation:
Department of Pediatrics, Northwestern University, Chicago, and Director of Hepatology, Department of Gastroenterology, Hepatology and Nutrition, Children’s Memorial Hospital, Chicago, IL, USA
Jaimie D. Nathan
Affiliation:
Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
Frederick C. Ryckman
Affiliation:
Pediatric Surgery Training Program, Pediatric Liver Care Center, Cincinnati Children’s Hospital, Cincinnati, OH, USA
Gregory M. Tiao
Affiliation:
Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
William F. Balistreri
Affiliation:
University of Cincinnati College of Medicine
Frederick J. Suchy
Affiliation:
University of Colorado Medical Center
Ronald J. Sokol
Affiliation:
University of Colorado Medical Center
William F. Balistreri
Affiliation:
University of Cincinnati College of Medicine
Get access

Summary

Introduction

Liver transplantation has become the standard of care for end-stage liver disease in children and successful outcomes are now achieved in the vast majority of transplant recipients. Progressive improvement has occurred through better preoperative care of patients with liver disease, improved operative techniques that has allowed the donor pool to expand, and improved immunosuppression strategies to prevent rejection while avoiding complications of over-immunosuppression. The success of the past, however, has also bred unique challenges for the future. With the increasing number of liver transplant candidates, improved donor awareness and organ availability must occur. A delicate balance between the risks assumed by living donors and the needs of their children must be struck. The increasing numbers of surviving patients present unique challenges and complications related to lifelong immunosuppression. The future success of pediatric liver transplantation will require appreciation of the increasingly complex care needs of this population and a national focus on donor organ shortages.

The evaluation process

Collective experience suggests that the progression of chronic liver disease is not linear, but rather exponential, suggesting that early warning signs of hepatic compromise, such as deteriorating synthetic function or refractory nutritional failure should lead to prompt evaluation. In children with acute liver failure (ALF) or rapidly progressive decompensation of chronic disease, aggressive critical care intervention is essential to maintain all other physiologic systems until a suitable donor organ becomes available.

Type
Chapter
Information
Liver Disease in Children , pp. 760 - 772
Publisher: Cambridge University Press
Print publication year: 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Studies of Pediatric Liver Transplantation Consortium. Annual Report 2007. Rockville, MD: Emmes, 2007.Google Scholar
Kasai, M, Mochizuki, I, Ohkohchi, N, et al. Surgical limitation for biliary atresia: indication for liver transplantation. J Pediatr Surg 1989;24:851–854.CrossRefGoogle ScholarPubMed
Altman, RP, Lilly, JR, Greenfeld, J, et al. A multivariable risk factor analysis of the portoenterostomy (Kasai) procedure for biliary atresia: twenty-five years of experience from two centers. Ann Surg 1997;226:348–353; discussion 353–355.CrossRefGoogle ScholarPubMed
Otte, JB, de Ville de Goyet, J, Reding, R, et al. Sequential treatment of biliary atresia with Kasai portoenterostomy and liver transplantation: a review. Hepatology 1994;20:41S–48S.Google ScholarPubMed
Englert, C, Grabhorn, E, Burdelski, M, Ganschow, R. Liver transplantation in children with Alagille syndrome: indications and outcome. Pediatr Transplant 2006;10:154–158.CrossRefGoogle ScholarPubMed
Morioka, D, Kasahara, M, Takada, Y, et al. Current role of liver transplantation for the treatment of urea cycle disorders: a review of the worldwide English literature and 13 cases at Kyoto University. Liver Transplant 2005;11:1332–1342.CrossRefGoogle Scholar
Whitington, PF. Neonatal hemochromatosis: a congenital alloimmune hepatitis. Semin Liver Dis 2007;27:243–250.CrossRefGoogle ScholarPubMed
Rand, EB, Karpen, SJ, Kelly, S, et al. Treatment of neonatal hemochromatosis with exchange transfusion and intravenous immunoglobulin. J Pediatr 2009;155:566–571.CrossRefGoogle ScholarPubMed
Lee, WS, Sokol RJ. Liver disease in mitochondrial disorders. Semin Liver Dis 2007;27:259–273.CrossRefGoogle ScholarPubMed
Dimmock, DP, Dunn, JK, Feigenbaum, A, et al. Abnormal neurological features predict poor survival and should preclude liver transplantation in patients with deoxyguanosine kinase deficiency. Liver Transplant 2008;14:1480–1485.CrossRefGoogle ScholarPubMed
Mindikoglu, AL, King, D, Magder, LS, et al. Valproic acid-associated acute liver failure in children: case report and analysis of liver transplantation outcomes in the United States. J Pediatr 2011;158:802–807.CrossRefGoogle ScholarPubMed
McClean, P, Davison, SM. Neonatal liver failure. Semin Neonatol 2003;8:393–401.CrossRefGoogle ScholarPubMed
Dhawan, A, Cheeseman, P, Mieli-Vergani, G. Approaches to acute liver failure in children. Pediatr Transplant 2004;8:584–588.CrossRefGoogle ScholarPubMed
Lee, WS, McKiernan, P, Kelly, DA. Etiology, outcome and prognostic indicators of childhood fulminant hepatic failure in the United Kingdom. J Pediatr Gastroenterol Nutr 2005;40:575–581.CrossRefGoogle ScholarPubMed
Baliga, P, Alvarez, S, Lindblad, A, Zeng, L. Posttransplant survival in pediatric fulminant hepatic failure: the SPLIT experience. Liver Transplant 2004;10:1364–1371.CrossRefGoogle ScholarPubMed
Rivera-Penera, T, Moreno, J, Skaff, C, et al. Delayed encephalopathy in fulminant hepatic failure in the pediatric population and the role of liver transplantation. J Pediatr Gastroenterol Nutr 1997;24:128–134.CrossRefGoogle ScholarPubMed
Otte, JB, Pritchard, J, Aronson, DC, et al. Liver transplantation for hepatoblastoma: results from the International Society of Pediatric Oncology (SIOP) study SIOPEL-1 and review of the world experience. Pediatr Blood Cancer 2004;42:74–83.CrossRefGoogle ScholarPubMed
Hertl, M, Cosimi, AB. Liver transplantation for malignancy. Oncologist 2005;10:269–281.CrossRefGoogle ScholarPubMed
Yao, FY, Ferrell, L, Bass, NM, et al. Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria. Liver Transplant 2002;8:765–774.CrossRefGoogle ScholarPubMed
Lu, BR, Esquivel, CO. A review of abdominal organ transplantation in cystic fibrosis. Pediatr Transplant 2010;14:954–960.CrossRefGoogle ScholarPubMed
Organ Procurement and Transplantation Network. Policies. Organ Distribution: Allocation of Livers. Bethesda, MD: US Health Resources and Services Administration, Department of Health & Human Services, 2013 (, accessed 26 July 2013).Google Scholar
Lao, OB, Dick, AA, Healey, PJ, et al. Identifying the futile pediatric liver re-transplant in the PELD era. Pediatr Transplant 2010;14:1019–1029.CrossRefGoogle ScholarPubMed
Freeman, RB, Edwards, EB. Liver transplant waiting time does not correlate with waiting list mortality: implications for liver allocation policy. Liver Transplant 2000;6:543–552.CrossRefGoogle Scholar
Organ Procurement and Transplantation Network. Final rule with comment period. Fed Regist 1998;63:16296–16338.Google Scholar
Freeman, RB, Wiesner, RH, Roberts, JP, et al. Improving liver allocation: MELD and PELD. Am J Transplant 2004;4(Suppl 9):114–131.CrossRefGoogle ScholarPubMed
Barshes, NR, Lee, TC, Udell, IW, et al. The pediatric end-stage liver disease (PELD) model as a predictor of survival benefit and posttransplant survival in pediatric liver transplant recipients LiverTransplant 2006;12:475–480.Google Scholar
Shneider, BL, Suchy, FJ, Emre, S. National and regional analysis of exceptions to the pediatric end-stage liver disease scoring system (2003–2004). Liver Transplant 2006;12:40–45.CrossRefGoogle Scholar
Carey, RG, Bucuvalas, JC, Balistreri, WF, et al. Hyponatremia increases mortality in pediatric patients listed for liver transplantation. Pediatr Transplant 2010;14:115–120.CrossRefGoogle ScholarPubMed
Urata, K, Kawasaki, S, Matsunami, H, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology 1995;21:1317–1321.CrossRefGoogle ScholarPubMed
Dahm, F, Georgiev, P, Clavien, PA. Small-for-size syndrome after partial liver transplantation: definition, mechanisms of disease and clinical implications. Am J Transplant 2005;5:2605–2610.CrossRefGoogle ScholarPubMed
Morimoto, T, Ichimiya, M, Tanaka, A, et al. Guidelines for donor selection and an overview of the donor operation in living related liver transplantation. Transplant Int 1996;9:208–213.CrossRefGoogle ScholarPubMed
Feng, S, Goodrich, NP, Bragg-Gresham, JL, et al. Characteristics Associated with graft failure: the concept of a donor risk index. Am J Transplant 2006;6:783–790.CrossRefGoogle ScholarPubMed
Cuende, N, Miranda, B, Cañón, JF, et al. Donor characteristics associated with liver graft survival. Transplantation 2005;79:1445–1452.CrossRefGoogle ScholarPubMed
Spitzer, AL, Lao, OB, Dick, AA, et al. The biopsied donor liver: incorporating macrosteatosis into high-risk donor assessment. Liver Transplant 2010;16:874–884.CrossRefGoogle ScholarPubMed
McDiarmid, SV, Davies, DB, Edwards, EB. Improved graft survival of pediatric liver recipients transplanted with pediatric-aged liver donors. Transplantation 2000;70:1283–1291.CrossRefGoogle ScholarPubMed
Emre, S, Soejima, Y, Altaca, G, et al. Safety and risk of using pediatric donor livers in adult liver transplantation. Liver Transplant 2001;7:41–47.CrossRefGoogle ScholarPubMed
Yasutomi, M, Harmsmen, S, Innocenti, F, et al. Outcome of the use of pediatric donor livers in adult recipients. Liver Transplant 2001;7:38–40.CrossRefGoogle ScholarPubMed
Burdelski, MM, Rogiers, X. What lessons have we learned in pediatric liver transplantation?J Hepatol 2005;42:28–33.CrossRefGoogle ScholarPubMed
Organ Procurement and Transplantation Network. Guidance for the Medical Evaluation of Potential Living Liver Donors. Bethesda, MD: US Health Resources and Services Administration, Department of Health & Human Services, 2013 (, accessed 26 July 2013).Google Scholar
Vulchev, A, Roberts, JP, Stock, PG. Ethical issues in split versus whole liver transplantation. Am J Transplant 2004;4:1737–1740.CrossRefGoogle ScholarPubMed
Ryckman, FC, Flake, AW, Fisher, RA, et al. Segmental orthotopic hepatic transplantation as a means to improve patient survival and diminish waiting-list mortality. J Pediatr Surg 1991;26:422–427; discussion 427–428.CrossRefGoogle ScholarPubMed
Renz, JF, Yersiz, H, Reichert, PR, et al. Split-liver transplantation: a review. Am J Transplant 2003;3:1323–1335.CrossRefGoogle ScholarPubMed
Lee, TC, Barshes, NR, Washburn, WK, et al. Split-liver transplantation using the left lateral segment: a collaborative sharing experience between two distant centers. Am J Transplant 2005;5:1646–1651.CrossRefGoogle ScholarPubMed
Faraj, W, Dar, F, Bartlett, A, et al. Auxiliary liver transplantation for acute liver failure in children. Ann Surg 2010;251:351–356.CrossRefGoogle ScholarPubMed
Strom, S, Fisher, R. Hepatocyte transplantation: new possibilities for therapy. Gastroenterology 2003;124:568–571.CrossRefGoogle ScholarPubMed
Ryckman, FC, Fisher, RA, Pedersen, SH, Balistreri, WF. Liver transplantation in children. Semin Pediatr Surg 1992;1:162–172.Google ScholarPubMed
Otte, JB, de Ville de Goyet, J, Sokal, E, et al. Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation. Ann Surg 1990;211:146–157.CrossRefGoogle ScholarPubMed
Inomoto, T, Nishizawa, F, Sasaki, H, et al. Experiences of 120 microsurgical reconstructions of hepatic artery in living related liver transplantation. Surgery 1996;119:20–26.CrossRefGoogle ScholarPubMed
Guarrera, JV, Sinha, P, Lobritto, SJ, et al. Microvascular hepatic artery anastomosis in pediatric segmental liver transplantation: microscope vs loupe. Transplant Int 2004;17:585–588.CrossRefGoogle ScholarPubMed
Tannuri, U, Mello, ES, Carnevale, FC, et al. Hepatic venous reconstruction in pediatric living-related donor liver transplantation: experience of a single center. Pediatr Transplant 2005;9:293–298.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×