Pediatric Recipient Considerations

  • Mar Miserachs
  • Vicky Lee Ng
Reference work entry
Part of the Organ and Tissue Transplantation book series (OTT)


Timely patient referral to an experienced pediatric liver transplant program should occur before the development of any contraindication or life-threatening complications. Selection of the potential pediatric candidate for liver transplant via a multidisciplinary evaluation process is key in achieving an ideal outcome for each and every patient. Unrecognized reversible medical conditions, alternative medical or surgical therapies and contraindications for liver transplant, will be identified. This chapter focuses on the evaluation of the patient for liver transplantation and provides an overview of the indications and contraindications for pediatric liver transplantation.


Liver transplantation Indications Contraindications Evaluation Referral, timing Children Biliary atresia 


  1. Amir AZ, Ling SC, Naqvi A et al. (2016) Liver transplantation for children with acute liver failure associated with secondary hemophagocytic lymphohistiocytosis. Liver Transpl 22:1245–1253.CrossRefPubMedGoogle Scholar
  2. Arnon R, Kerkar N, Davis MK et al (2010) Liver transplantation in children with metabolic diseases: the studies of pediatric liver transplantation experience. Pediatr Transplant 14:796–805CrossRefPubMedGoogle Scholar
  3. Aronson DC, Schnater JM, Staalman CR et al (2005) Predictive value of the pretreatment extent of disease system in hepatoblastoma: results from the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 study. J Clin Oncol 23:1245–1252CrossRefPubMedGoogle Scholar
  4. Balisteri WF, Grand R, Hoofnagle JH et al (1996) Biliary atresia: current concepts and research directions. Summary of a symposium. Hepatology 23:1682–1692CrossRefGoogle Scholar
  5. Carter-Kent C, Radhakrishnan K, Feldstein AE (2007) Increasing calories, decreasing morbidity and mortality: is improved nutrition the answer to better outcomes in patients with biliary atresia? Hepatology 46:1329–1331CrossRefPubMedGoogle Scholar
  6. Chai PF, Lee WS, Brown RM et al (2010) Childhood autoimmune liver disease: indications and outcome of liver transplantation. J Pediatr Gastroenterol Nutr 50:295–302CrossRefPubMedGoogle Scholar
  7. Colombo C, Battezzati PM, Crosignani A et al (2002) Liver disease in cystic fibrosis: a prospective study on incidence, risk factors and outcome. Hepatology 36:1374–1382CrossRefPubMedGoogle Scholar
  8. Dhawan A (2012) Acute liver failure in children and adolescents. Clin Res Hepatol Gastroenterol 36:278–283.CrossRefPubMedGoogle Scholar
  9. DeRusso PA, Ye W, Shepherd R et al (2007) Growth failure and outcomes in infants with biliary atresia: a report from the Biliary Atresia Research Consortium. Hepatology 46:1632–1638CrossRefPubMedGoogle Scholar
  10. Hartley JL, Davenport M, Kelly DA (2009) Biliary atresia. Lancet 374:1704–1713CrossRefPubMedGoogle Scholar
  11. Kamath BM, Olthoff KM (2010) Liver transplantation in children: update 2010. In: Ng VL, Feng S (eds) Optimization of outcomes for children after solid organ transplantation, vol 57, Pediatric Clinics of North America. Saunders, Philadelphia, pp 401–414Google Scholar
  12. Kamath BM, Yin W, Miller H et al (2012) Outcomes of liver transplantation for patients with Alagille syndrome: the studies of pediatric liver transplantation experience. Liver Transpl 18:940–948CrossRefPubMedGoogle Scholar
  13. Kayler LK, Merion RM, Lee S et al (2002) Long-term survival after liver transplantation in children with metabolic disorders. Pediatr Transplant 6:295–300CrossRefPubMedGoogle Scholar
  14. Kayler LK, Rasmussen CS, Dykstra DM (2003) Liver transplantation in children with metabolic disorders in the United States. Am J Transplant 3:334–339CrossRefPubMedGoogle Scholar
  15. Lykavieris P, van Mil S, Cresteil D et al (2003) Progressive familial intrahepatic cholestasis type 1 and extrahepatic features: no catch-up of stature growth, exacerbation of diarrhea, and appearance of liver steatosis after liver transplantation. J Hepatol 39:447–452CrossRefPubMedGoogle Scholar
  16. Malogolowkin MH, Katzenstein HM, Krailo M et al (2012) Treatment of hepatoblastoma: the North American cooperative group experience. Front Biosci (Elite Ed) 4:1717–1723CrossRefGoogle Scholar
  17. Mazariegos G, Shneider B, Burton B et al (2014) Liver transplantation for pediatric metabolic disease. Mol Genet Metab 111:418–427CrossRefPubMedGoogle Scholar
  18. Mieli-Vergani G, Vergani D (2011) Autoimmune liver diseases in children – what is different from adulthood? Best Pract Res Clin Gastroenterol 25:783–795CrossRefPubMedGoogle Scholar
  19. Mindikoglu AL, King D, Magder LS, et al (2011) Valproic acid associated acute liver failure in children: case report and analysis of liver transplantation outcomes in the United States. J Pediatr 158:802–807CrossRefPubMedGoogle Scholar
  20. Ng V, Anand R, Martz K et al (2008) Liver retransplantation in children: a SPLIT database analysis of outcome and predictive factors for survival. Am J Transplant 8:386–395CrossRefPubMedGoogle Scholar
  21. Rivera-Penera T, Moreno J, Skaff C et al (1997) Delayed encephalopathy in fulminant hepatic failure in the pediatric population and the role of liver transplantation. J Pediatr Gastroenterol Nutr 24:128–134CrossRefPubMedGoogle Scholar
  22. Romano F, Stroppa P, Bravi M et al (2011) Favorable outcome of primary liver transplantation in children with cirrhosis and hepatocellular carcinoma. Pediatr Transplant 15:573–579PubMedGoogle Scholar
  23. Shiboski CH, Kawada P, Golinveaux M et al (2009) Oral disease burden and utilization of dental care patterns among pediatric solid organ transplant recipients. J Public Health Dent 69:48–55CrossRefPubMedPubMedCentralGoogle Scholar
  24. Shneider BL, Brown MB, Haber B et al (2006) A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr 148:467–474CrossRefPubMedGoogle Scholar
  25. Siebold L, Dick AA, Thompson R et al (2010) Recurrent low gamma-glutamyltranspeptidase cholestasis following liver transplantation for bile salt export pump (BSEP) disease (posttransplant recurrent BSEP disease). Liver Transpl 16:856–863CrossRefPubMedGoogle Scholar
  26. Sokal EM, Sokol R, Cormier V et al (1999) Liver transplantation in mitochondrial respiratory chain disorders. Eur J Pediatr 158(Suppl 2):S81–S84CrossRefPubMedGoogle Scholar
  27. Sokol RJ, Stall C (1990) Anthropometric evaluation of children with chronic liver disease. Am J Clin Nutr 52:203–208CrossRefPubMedGoogle Scholar
  28. Soltys KA, Mazariegos GV, Squires RH et al (2007) Late graft loss or death in pediatric liver transplantation: an analysis of the SPLIT database. Am J Transplant 7:2165–2171CrossRefPubMedGoogle Scholar
  29. Squires RH, Shneider BL, Bucuvalas J et al (2006) Acute liver failure in children: the first 348 patients in the pediatric acute liver failure study group. J Pediatr 148:652–658CrossRefPubMedPubMedCentralGoogle Scholar
  30. Squires RH, Ng V, Romero R et al (2014) Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 59:112–131CrossRefPubMedGoogle Scholar
  31. Stevenson T, Millan MT, Wayman K et al (2010) Long-term outcome following pediatric liver transplantation for metabolic disorders. Pediatr Transplant 14:268–275CrossRefPubMedGoogle Scholar
  32. Studies of Pediatric Liver Transplantation Consortium (2007) Annual report 2007. Emmes, RockvilleGoogle Scholar
  33. Varela-Fascinetto G, Castaldo P, Fox IJ et al (1998) Biliary atresia-polysplenia syndrome: surgical and clinical relevance in liver transplantation. Ann Surg 227:583–589CrossRefPubMedPubMedCentralGoogle Scholar
  34. Whitington PF, Balisteri WF (1991) Liver transplantation in pediatrics: indications, contraindications, and pretransplant management. J Pediatr 118:169–177CrossRefPubMedGoogle Scholar
  35. Yu SB, Kim HY, Eo H et al (2006) Clinical characteristics and prognosis of pediatric hepatocellular carcinoma. World J Surg 30:43–50CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.The Hospital for Sick ChildrenTorontoCanada
  2. 2.Division of Pediatric Gastroenterology, Hepatology and Nutrition and SickKids Transplant and Regenerative Medicine Center, The Hospital for Sick ChildrenUniversity of TorontoTorontoCanada

Personalised recommendations