Pediatric transplantation

Advances in organ preservation, surgical technique, and post operative care have permitted the rapid development of liver transplantation in children. Consequently, the applicability of this procedure has gone beyond the trea tment of life-threatening complications of chronic liver disease and now in cludes disabling morbidities and quality-of-lifo issues. The use of hepatic segments for transplantation with reduced or split cadaveric grafts and li ving-related donors has decreased the mortality of children awaiting liver transplantation. We are presently armed with a new potent immunosuppressive drug, tacrolimus, and an understanding that the migration and grafting of passenger leukocytes of bone marrow origin is the seminal explanation for a llograft acceptance. The next forefront will involve manipulation of the pr ocess, not only for the transplantation of already successful whole organs- such as the liver, kidney, pancreas, and heart-but also in the development of the intestinal transplantation program. Thus, augmentation of leukocyte traffic in unconditioned recipients of cadaver allografts with concomitant intravenous infusion of donor bone marrow cells under the same immunosuppre ssive management of tacrolimus-prednisone will be the path to the future.