Liver transplantation in children: an update.

Liver transplantation in children has progressed to the point where much of the initial skepticism surrounding the value of this extraordinary endeavor has been overcome, and the results clearly justify the widespread use of this procedure in children with limited life expectancy secondary to severe liver disease. Advances in the areas of organ preservation and reduced-size liver transplantation have increased organ availability for children and significantly decreased mortality on transplant waiting lists. Changes in the ways pediatricians and pediatric surgeons think about children with EHBA have led to an increasing level of sophistication in combining the traditional surgical and medical treatments of this disease with the developing field of transplantation to maximize the chances for a normal life for all children with this problem. Newer immunosuppressive agents and more rational use of available medications have led to fewer graft losses to rejection while minimizing the undesirable side effects of individual drugs. As our understanding of the delicate interaction between the immune system and the graft increases, newer methods of immunomodulation may yet lead to the eventual goal of donor-specific tolerance, in which all immunologic reactivity remains normal except with respect to donor antigens on the graft. More specific immunosuppressive agents and more effective antiviral strategies have led to a decreased mortality from viral infections and may lead to a decrease in the mortality from secondary malignant disease. As mere survival after liver transplantation becomes more commonplace, more effort can be directed into meeting the long-term psychological and social needs of children with liver transplants to ensure that children develop and grow in as normal a manner as possible.