The diseases that lead to chronic liver disease in children can be separated into groups according to their age of onset.

The illnesses that begin at or shortly after birth include biliary atresia, intrahepatic cholestasis syndromes, and metabolic liver diseases.

In children over one year of age, acute and chronic hepatitis, acute hepatic failure, and other metabolic diseases predominate. A unique pediatric transplant indication is growth failure as a consequence of progressive hepatic metabolic failure and anorexia. If growth failure persists, then the child is listed for transplant. Occasionally, children require transplantation when their liver disease has progressed to the point where it interferes with their quality of life.

The absolute contraindications to transplantation are few: the presence of any active, untreated bacterial, fungal, or viral infection at the time of transplantation; metastatic cancer to the liver; or liver cancer that has spread beyond the liver. Pediatric liver transplantation requires special expertise.

Efforts have been made to adapt the adult donor liver to pediatric recipients. Reduced size transplantation is a technique that involves performing either a right lobectomy or a right trisegmentectomy on the donor organ, yielding either a left lobe or left lateral segment for transplantation. The grafts grow with the children, and the survival rate after RST is equal to that of whole organ transplantation.

The early complications after transplantation including hepatic artery thrombosis and biliary strictures are well recognized and new techniques are being developed to minimize their occurrence.

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