Paediatric liver transplantation-a review based on 20 years of personal experience

Abstract

The natural history of most liver diseases requiring liver replacement in children is well known, and the potential of this therapy has been ascertained regarding life expectancy, which currently exceeds 90% in the long term. The timing of liver transplantation must be anticipated, to reduce the physical, psychological and mental impact of chronic liver diseases. Several studies show evidence that the best long-term results with regard to patient and graft survival are obtained with grafts procured from relatively young donors. Since the shortage of post-mortem liver donors will most likely worsen, further development of live, relateddonor transplantation can be expected. The main progress to come will concern immunosuppression, taking advantage of the immunological privilege of the liver. Protocols are under development for induction of operational tolerance.Keywords Children . Liver transplantation * Indications . Survival . Medical complications * Immunosuppression HistoryThe history of paediatric liver transplantation cannot be dissociated from the name of Thomas E. Starzl, whose pioneering and ever-continuing efforts contributed more than anyone else's to what has become a routinely successful procedure [ 1, 21. I had the unique privilege to be his research fellow during my 3rd-year surgical residency (1965)(1966).His first attempt, performed in 1963 in a child with biliary atresia, failed [3]. Four of the eight children that received transplants in 1967 survived beyond 1 year; one is still alive, in perfect clinical condition, off immunosuppression for > 17 years (T.E. Starzl, personal communication). Cyclosporine, introduced in 1980, allowed the long-term survival of the majority of children that had received transplants [4]. After its transfer to the University of Pittsburgh in 1981, the liver programme of T.E. Starzl expanded impressively, with 808 children ( < 18 years) receiving a transplant between March 198 1 and April 1998 [5].In Europe, liver transplantation in a 10-month-old child with biliary atresia was attempted in Cambridge, UK, by Sir Roy Calne [6] in June 1968; the child died during surgery.In continental Europe, we performed, in March 1971, the first successful liver transplantation in an 18-monthold child with biliary atresia [7]. Our programme really started in 1984, on a multidisciplinary paediatric basis, after the transfer of our university hospital from Leuven to Brussels. The first four children are still alive, having reached 20 years of post-transplant survival. From 1984 to 2003 our group performed liver transplantation in 593 children ( < 15 years), including 120 patients who re-563 ceived a live, related-donor transplant. Most of those children were referred from abroad. Prof. Daniel Alagille [8] was the first to put his trust in our group. In 1985 we started a 3-year collaboration while awaiting the implementation of a liver programme in HBpitalBicgtre, Paris. We were honoured by the collaboration with this distinguished paediatric hepatologist, who was an internatio...

Current Lifestyle of Young Adults After Liver Transplantation During Childhood

“…Currently, these rates exceed 80% 10 years after LT, and an increasing number of children who underwent LT early in life survive into adulthood (1)(2)(3)(4)(5). Nearly (QOL) and that QOL improves with time after transplantation (6)(7)(8)(9)(10)(11)(12).…”