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Pediatric Liver Transplantation: Selection Criteria and Post-transplant Medical Management

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Abstract

Pediatric liver transplantation remains the gold standard for life-threatening acute and chronic liver diseases and multiple liver-based inherited metabolic defects. Advances in surgical techniques, better perioperative care and immunosuppression regimes have resulted in excellent long-term graft and patient survival. The success of pediatric liver transplantation does however bring the additional challenge of long-term patient outcomes including graft hepatitis-related fibrosis and suboptimal biopsychosocial outcomes. In this review, authors will explore the current landscape of pediatric liver transplantation including indications, timing of referral for liver transplantation, surgical techniques and long-term outcomes such as recurrence of pre-transplant liver disease, idiopathic graft hepatitis and biopsychosocial outcomes. Ultimately, early identification and management of potential issues long-term helps ensure our recipients achieve a “meaningful survival”.

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Authors and Affiliations

  1. Pediatric Liver GI and Nutrition Centre and Mowat Labs, King’s College Hospital, London, SE5 9RS, UK

    Sunitha Vimalesvaran, Anita Verma & Anil Dhawan

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  1. Sunitha Vimalesvaran
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  2. Anita Verma
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  3. Anil Dhawan
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All authors were involved in the writing, analysis and review of this article. AD will act as guarantor for this manuscript.

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Appendix

Appendix

Acute liver failure super-urgent listing transplant criteria in the UK are based on National Health Service Blood and Transplant (NHSBT) criteria [5]

National Health Service Blood and Transplant (NHSBT) Criteria for Pediatric Acute Liver Failure (Super-urgent listing)

Acute liver failure in children under two years of age: INR >4 or grade 3–4 encephalopathy

Acute presentation of Wilson’s disease, or Budd-Chiari syndrome: A combination of coagulopathy, and any grade of encephalopathy

Paracetamol poisoning: pH <7.25 more than 24 h after overdose and after fluid resuscitation or

co-existing prothrombin time >100 s or INR >6.5, and serum creatinine >300 μmol/l or anuria, and grade 3–4 encephalopathy or persistent hyperlactatemia after adequate fluid resuscitation

Favorable non-paracetamol etiologies such as acute viral hepatitis: The presence of clinical hepatic encephalopathy is mandatory and: prothrombin time >100 s, or INR >6.5, or any three from the following: age <10 y; prothrombin time >50 s or INR >3.5; any grade of hepatic encephalopathy with jaundice to encephalopathy time >7 d; serum bilirubin >17.5 mg/dL

Unfavorable non-paracetamol etiologies such as seronegative or idiosyncratic drug reactions: a) prothrombin time >100 s, or INR >6.5, or b) in the absence of clinical hepatic encephalopathy then INR >2 after vitamin K repletion is mandatory and any two from the following: age <10 y; prothrombin time >50 s or INR >3.5; if hepatic encephalopathy is present then jaundice to encephalopathy time >7 d; serum bilirubin >17.5 mg/dL

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Vimalesvaran, S., Verma, A. & Dhawan, A. Pediatric Liver Transplantation: Selection Criteria and Post-transplant Medical Management. Indian J Pediatr 91, 383–390 (2024). https://doi.org/10.1007/s12098-023-04963-5

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