Restoring normal growth and development in children that have survived end-stage liver disease and liver transplantation is a complex challenge. Advancing growth failure prior to transplant may have a negative impact on posttransplant survival, growth potential, and cognitive development. Yet, with the current organ allocation scheme, most infants and children with chronic liver disease will experience advanced malnutrition and resulting growth failure before they have an opportunity to receive a liver graft. Although physical and developmental "catch-up" is observed for many children, some do not completely overcome pretransplant deficits. Approaches to posttransplant medical therapy, such as steroid minimization, may improve outcomes. The cognitive function of the majority of patients is within the normal range. Yet, a relatively high percentage are not functioning at the level that would be predicted by their IQ, and the specific causes of learning problems in this group must be more fully explored. HRQOL and functional outcomes are comparable to those of other pediatric groups with chronic disease but are lower than those of a normative population. Parents of pediatric liver transplant recipients report more stress and tend to report functional outcomes that are lower than those reported by the children themselves.
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