Five of seven pediatric liver transplant recipients with SRR experienced successful outcomes with basiliximab treatment without major side effects, indicating that it is a safe alternative to OKT3 and other antilymphocyte antibodies.

Cytomegalovirus (CMV) infection is a major concern following solid organ transplantation, especially in the pediatric population who remain at high risk of primary infection. CMV disease leads not only to increased patient and graft morbidity, but also to increased health care costs. This study describes the usefulness of a quantitative CMV polymerase chain reaction (PCR) technique for monitoring peripheral blood CMV DNA in pediatric recipients of kidney and liver allografts who had recurrent CMV retinitis. The incidence of CMV disease in 28 pediatric transplant recipients was 28.6%, one-half of whom developed retinitis. Two of these patients had recurrent retinitis on cessation of anti-viral treatment. A peripheral blood CMV DNA copy number of > or =500/microg of DNA was associated with recrudescence of the retinitis in these patients. We conclude that the measurement of peripheral blood CMV DNA by PCR is a useful tool for the surveillance of disease resolution and recurrence. This is particularly important in patients with CMV retinitis, who may remain asymptomatic for a period of time, despite recurrences.

The outcome of fulminant hepatic failure without timely liver transplantation is poor. We describ e a 19·ye ar·old woman with fulminant hepa tic failure due to acute hepatitis B infection who received a living donor liver transplan t from her sister. The donor 's recovery was uneventful, allowing hospital discharge on Day 6. Two month s after transplantation the recipien t developed a biliary stricture requiring surgery. One year after transplantation, her liver function was normal. (MJA 2001; 175: 202-204) W ITHOUT LIVER TRANSPLM'TATION, th e prognos is for fu lminant hepatic failure is ext remely pOOL l A shorta ge of cadaver don ors has resulted in some pa tients d ying wh ile waiting for a suitable dono r.' In Western Austra lia, our experience is th at 60 % of patie nt s with fulm inant hepatic failure die befo re a ca dave r liver becomes available. L iving do nor liver tr ansplantation was initially deve loped to circu mvent waiting list deaths in ch ildren. The technique was su bsequently expa nded to incl ude ad ult pat ients because ofinsufficien t availab ility of cadaveric organs. J Wh ile ad ult-to-child living donor liver tr ans plantat ion is a rela tively safe and accepted p ractice: adu'r-ro-adulr living donor liver tr an splantation is sti ll controvers ial. T he concern is that, because adu lt recipients require larger gra fts, heal th y ad ult donors may be at greater risk of death or complications."The world experience in adult-to -adult living do no r liver transplantation is rapidly increasing, and m any studies show recip ient outcomes similar to th ose with whole-or gan implants, as well as low donor risk. 2 • M • 9