The Indian Journal of Pediatrics

, Volume 69, Issue 2, pp 175–183 | Cite as

Liver transplantation in children

  • Mohamed RelaEmail author
  • Anil Dhawan
Symposium on Hematology-II


The results of liver transplantation has improved significantly in the last decade with one year survival figures close to 90% for children with chronic liver disease. This can be attributed to improvement in surgical techniques, better postoperative care and newer immunosuppresive drugs. As a result of this, increasing number of children are referred for transplantation with no significant increase in the number of solid organ donors. The earliest transplants in children were performed using organs from size matched pediatric donors. However, as the pediatric donor numbers were limited, liver reduction techniques were developed to transplant small children before deterioration. Increasing experience with reduced livers led to the development of split liver, living donor and auxiliary liver transplantation. Better management of immunosuppressive drugs and newer agents such as Mycophenolate Mofetil have reduced the incidence of graft loss due to chronic rejection and long-term renal toxicity. The goal for the future will remain to be transplantation without the use of longterm immunosuppression.

Key words

Liver Transplantation Children Techniques Immunosuppression 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Starzl TE, Marchioro TL, Von Kaulla Ket al. Homotransplantation of the liver in humans.Surg Gynecol Obstet 1963; 117: 659–676.PubMedGoogle Scholar
  2. 2.
    Calne RY, Williams R. Liver transplantation in man I. Observation on technique and organisation in 5 cases.Brit Med J 1968; 4: 535–540.PubMedCrossRefGoogle Scholar
  3. 3.
    Rela M, Vougas V, Muiesan Pet al. Split liver transplantation: King’s College Hospital experience.Ann Surg. 1998; 227(2): 282–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Deshpande RR, Matthew JB, Hector Vilca-Melendez, Parthi Srinivasan, Raffaele Girlanda, Anil Dhawanet al. Results of Split Liver Transplantation In Children.Ann of Surg 2002 (in press)Google Scholar
  5. 5.
    Inomata Y, Tanaka K, Ulemoto S, Egawa H, Kiuchi T, Fujita S, Hayashi. Living donor liver transplantation: an 8-year experience with 379 consecutive cases.Transplant Proc 1999; 31(1-2): 381.PubMedCrossRefGoogle Scholar
  6. 6.
    Pereira S, McCarthy M, Ellis A, Wendon AJ, Rela M, Heaton NDet al. Auxiliary Partial Orthotopic liver transplantation for acute liver failure.J Hepatol 1997; 26: 1010–1017.PubMedCrossRefGoogle Scholar
  7. 7.
    M Rela, P Muiesan, H Vilca-Melendez, A Dhawan, A Baker, G Mieli-Verganiet al. Auxiliary orthotopic liver transplantation for Crigler Najjar Syndrome Type 1.Ann Surg 1999; 229: 565–569.PubMedCrossRefGoogle Scholar
  8. 8.
    Kahan BD. Drug therapy-cyclosporine.N Eng J Med 1989; 321: 1725–1738.CrossRefGoogle Scholar
  9. 9.
    Kilpe VE, Krakauer H, Wren RE. An analysisof liver transplant experience from 37 transplant centers as reported to Medicare.Transplantation 1993; 56: 554–561PubMedCrossRefGoogle Scholar
  10. 10.
    Shaw BW Jr, Wood RP, Stratta RJ, Pillen TJ, Langnas AN. Stratifying the causes of death in liver transplant recipients. An approach to improving survival.Arch Surg 1989; 124: 895–900.PubMedGoogle Scholar
  11. 11.
    Busuttil RW, Seu P, Millis JM, Olthoff KM, Hiatt JR, Milewicz A. Liver transplantation in children.Ann Surg 1991; 213: 48–57.PubMedCrossRefGoogle Scholar
  12. 12.
    Otte JB, de Ville de Goyet J, Sokal E, Alberti D, Moulin D, de Hemptinne Bet al. Size reduction of the donor liver is a safe way to alleviate the shortage of size-matched organs in pediatric liver transplantation.Ann Surg 1990; 211: 146–157.PubMedCrossRefGoogle Scholar
  13. 13.
    Broelsch CE, Emond JC, Thistlethwaite JR, Whirington PF, Zucker AR, Baker ALet al. Liver transplantation, including the concept of reduced-size liver transplants in children.Ann Surg 1988; 208: 410–420.PubMedCrossRefGoogle Scholar
  14. 14.
    Busuttil RW, Seu P, Millis JM, Olthoff KM, Hiatt JR, Milewicz Aet al. Liver transplantation in children.Ann Surg 199; 213 : 48–57.Google Scholar
  15. 15.
    Shaw BW Jr, Wood RP, Stratta RJ, Pillen TJ, Langnas AN. Stratifying the causes of death in liver transplant recipients. An approach to improving survival.Arch Surg 1989; 24: 895–900.Google Scholar
  16. 16.
    Bonatti H, Muiesan P, Connelly S, Baker A, Mieli-Vergani G, Gibbs, P,Net al. Liver transplantation in children tinder 3 months of age: A single centre’s experience.J Pediatr Surg 1997; 32: 486–488.PubMedCrossRefGoogle Scholar
  17. 17.
    Bilik R, Yellen M, Superina RA. Surgical complications in children after liver transplantation.J Pediatr Surg 1992; 27: 1371–1375.PubMedCrossRefGoogle Scholar
  18. 18.
    Rela M, Muiesan P, Bhatnagar V, Baker A, Mowat AP, Mieli Vergani Get al. Hepatic artery thrombosis after liver transplantation in children under 5 years of age.Transplantation 1996; 15; 6: 1355–1357.CrossRefGoogle Scholar
  19. 19.
    Langnas AN, Marujo W, Stratta RJ, Wood RP, Shaw BW Jr. Vascular complications after orthotopic liver transplantation.Am J Surg 1991; 161: 76–82.PubMedCrossRefGoogle Scholar
  20. 20.
    Bhatnagar V, Dhawan A, Haider C, Muiesan P, Rela M, Mowat APet al. The incidence and management of biliary complications following liver transplantation in children.Transpl Int 1995; 8: 388–391.PubMedCrossRefGoogle Scholar
  21. 21.
    Vilca Melendz H, Vougas V, Muiesan P, Andreani P, Mieli-Vergani G, Rela Met al. Bowel perforation after paediatric orthotopic liver transplantation.Transpl Int 1998; 11: 301–304.CrossRefGoogle Scholar
  22. 22.
    Mellon A, Shepherd RW, Faoagali JL, Balderson G, Ong TH, Patrick Met al. Cytomegalovirus infection after liver transplantation in children.J Gastroenterol Hepatol 1993; 8: 540–544.PubMedCrossRefGoogle Scholar
  23. 23.
    Morgan G, Superina RA. Lymphoproliferative disease after pediatric liver transplantation.J Ped Surg 1994; 29: 1192–1196.CrossRefGoogle Scholar
  24. 24.
    Malatack JJ, Gartner JC, Urbach AH, Zitelli BJ. Orthotopic liver transplantation, Epstein-Barr virus, cyclosporin, and lymphoproliferative disease: A growing concern.J Pediatr 1991; 118: 667–675.PubMedCrossRefGoogle Scholar
  25. 25.
    Penn I. Cancers complicating organ transplantation. (Editorial)N Engl J Med 1990; 323: 1767–1769.PubMedCrossRefGoogle Scholar
  26. 26.
    Stephan JL, Le Deist F, Blanche S, LeBidois J, Peuchmaur M, Lellouch-Tubiana Aet al. Treatment of central nervous system B lympherative proliferative syndrome by local infusion of a B cell-specific monoclonal antibody.Transplantation 1992; 54: 246–249.PubMedCrossRefGoogle Scholar
  27. 27.
    Marion MA, Beatrice Samaroo, Alastair Baker, Anita Verma, Mohamed Rela, Nigel Heatonet al. Calcineurin-Inhibitor related nephrotoxicity — Reversibility in paediatric liver transplant recipients.Transplantation 2000; 72: 746–749.Google Scholar
  28. 28.
    Klintmalm GB, Nery JR, Husberg BS, Gonwa TA, Tfflery GW. Rejection in liver transplantation.Hepatology 1989; 10: 978–985.PubMedCrossRefGoogle Scholar
  29. 29.
    Chin SE, Shepherd RW, Cleghorn GJ. Survival, growth and quality of life in children after orthotopic liver transplantation; A 5-year experience.J Pediatr Child Health 1991; 7: 380–385.CrossRefGoogle Scholar
  30. 30.
    Midgley DE, Bradlee TA, Donohoe C, Kent KP, Alonso EM. Health-related quality of life in long-term survivors of pediatric liver transplantation.Liver Trans 2000; 6: 333–339.CrossRefGoogle Scholar
  31. 31.
    Penn I, Bunch D, Olenik Det al. Psychiatric experience with patients receiving renal and hepatic transplants.Semin Psychiatry 1971; 3: 133–134.PubMedGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2002

Authors and Affiliations

  1. 1.Department of Child Health King’s College HospitalInstitute of Liver StudiesLondonEngland

Personalised recommendations