Paediatric liver transplantation: Indications, timing and medical complications

Newer surgical techniques and immunosuppressive therapies have resulted in paediatric liver transplantation being available for most children with end -stage liver disease and has resulted in a greater than 80% 5-year survival rate. The most common indications for paediatric liver transplantation are biliary atresia (43%), metabolic disease (13%) and acute hepatic necrosis (11%). For approximately 75% of children with acute hepatic failure, the ca use is unknown. Timing of liver transplantation not only affects survival r ate, but may influence neurodevelopmental outcome. Fortunately, numerous ty pes of donors, such as reduced-sized, living related or unrelated and blood -type mismatched, have reduced the mortality of children who are waiting fo r liver transplantation. However, the, mortality and morbidity before and a fter liver transplantation remain high for children who have fulminant hepa tic failure or are less than 5 months of age at the time of transplantation . The principle medical complications after liver transplantation are rejec tion and infection. Although use of newer immunosuppressive regimens has re duced the rate of rejection, Epstein-Barr virus infection with associated l ymphoproliferative disorder remains the principle cause for morbidity and m ortality after the initial 3 months post-liver transplant.