BACKGROUND: Significant progress has been made with liver and intestinal tr
ansplantation in pediatric patients. Shortage of whole-organ cadaveric graf
ts has resulted in a high mortality rate for children awaiting transplantat
ion. New surgical procedures such as split-liver transplantation and living
-related liver transplantation have evolved over the last decade to maximiz
e donor utilization in pediatric patients.
METHODS: In this article we review the current indications and contraindica
tions for liver and intestinal transplantation in children, the surgical in
novations to expand an exceedingly small cadaveric liver pool, postoperativ
e management, and the impact on patient and graft survival.
RESULTS: Reduced-size liver transplantation provides children with much nee
ded small grafts; however, split-liver transplantation may eliminate the ne
ed for reduced-size and living-related liver transplantation except in urge
nt situations.
CONCLUSION: Liver transplantation is a durable procedure that provides exce
llent long-term survival. The use of living-related and split-liver transpl
antation has dramatically reduced the waiting periods for children and impr
oved Survival. In the past decade significant progress has been made with i
ntestinal transplantation owing to improvements in surgical technique, immu
nosuppressive agents, and early identification and treatment of postoperati
ve complications. Am J Surg. 2000;180:328-334. (C) 2000 by Excerpta Medica,
Inc.