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A review of the long-term outlook of children and young people post liver transplant

Nicola Ruth & Deirdre Kelly

The spectrum of pediatric liver disease is wide, encompassing a number of causes both acute and chronic including metabolic, infective, malignant, drug-induced, autoimmune and idiopathic. Liver transplant is life changing. It is a successful treatment for end-stage liver disease and has been widely available in the UK as a treatment option for over 30 years. Prior to this, patients inevitably succumbed to their underlying condition. Early survival rates post-transplant were low (28%) due to the complications encountered, including rejection due to inadequate immunosuppression, biliary and vascular complications. There have been many advances in management, including development of our understanding of immunosuppression, as well as better medical and surgical management in the peritransplant period. Innovative surgical techniques such as reduced or split adult donor grafts or living donor grafts have transformed the ability to transplant pediatric recipients who rarely survive long enough to obtain a whole liver.