Home | | Paediatrics | Paediatrics: Liver transplantation

Chapter: Paediatrics: Gastroenterology and nutrition

Paediatrics: Liver transplantation

Indications for liver transplantation, Clinical features requiring consideration for transplantation, Post-transplant complications.

Liver transplantation


Indications for liver transplantation


The commonest underlying conditions leading to irreversible liver failure and transplant are:

Fulminant hepatic failure: e.g. viral, toxic, Wilson’s disease.


Biliary atresia.


Chronic end-stage liver disease: e.g. post-viral hepatitis with cirrhosis.


Liver based metabolic conditions: e.g. Wilson’s disease, α1-antitrypsin deficiency, Crigler–Najjar syndrome, tyrosinaemia.


·Acute liver failure following a liver transplant: e.g. primary non-function of transplant or hepatic artery thrombosis.


Neonatal hepatitis.


Autoimmune hepatitis.


Unresectable tumour confined to the liver: e.g. hepatoblastoma.


Clinical features requiring consideration for transplantation


Bleeding varices due to portal hypertension.


Failure of growth or development.


Resistant ascites.


Hepatic encephalopathy.


Poor quality of life: e.g. pruritis, lethargy.


Coagulopathy (PTT >2 x normal).


Multi-organ failure: e.g. hepatorenal syndrome, hepatopulmonary syndrome.



Preparation for transplant


Requires multidisciplinary evaluation to include the following:

Nutritional support.


Development and psychological assessment of child and family.


Education and counseling.


Ensure vaccinations are current: e.g. MMR, varicella, hepatitis A and B.


Cardiac evaluation (ECG, echocardiogram).


·Abdominal US (patency of major hepatic blood vessels).


Post-transplant complications


Primary non-function of the liver (<5%).


Hepatic artery thrombosis (10–15%).


Biliary leaks and strictures (20%).


Acute rejection (50%).


Chronic rejection (5–10%).


Sepsis (main cause of death).




Long-term studies indicate normal psychosocial development and quality of life in survivors. Patients require lifelong immunosuppression drug ther-apy, e.g. ciclosporin or tacrolimus.

1yr survival is 90%.


   5yr survival is 80%.


Study Material, Lecturing Notes, Assignment, Reference, Wiki description explanation, brief detail
Paediatrics: Gastroenterology and nutrition : Paediatrics: Liver transplantation |

Privacy Policy, Terms and Conditions, DMCA Policy and Compliant

Copyright © 2018-2024 BrainKart.com; All Rights Reserved. Developed by Therithal info, Chennai.