Current concepts in pediatric liver transplant

Orthotopic liver transplantation has significantly improved the survival rate of children with end stage liver disease. Efforts to correct abnormalities existing prior to transplantation coupled with improved surgical techniques and immunosuppression have led to better quality of life and 1-year survival rates approaching 90% in many centers, Despite this success the expanding waiting list population of all ages has driven development of operative techniques to expand the donor pool. Building on the success of reduced-size transplantation, split-liver and living-donor transplantation are now suitable alternatives, especially when used in candidates with satisfactory clinical stability In the post-operative period, infectious complications represent an important cause of morbidity and mortality Although antimicrobial regimens are effective in the immediate post-operative phase, acquisition of viral infections represents a major concern particularly in the young liver recipient. Early detection and development of new anti-viral agents are likely to decrease occurrence of post-transplant proliferative disorders and optimize long term transplantation outcome.