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Pediatric Liver Transplantation

University of Pennsylvania Health System

Kim M. Olthoff, MD

University of Pennsylvania Health System, kim.olthoff{at}uphs.upenn.edu

Liver transplantation can be considered for any child with end-stage liver disease due to acute or chronic liver disease. The most common indications are biliary atresia, metabolic diseases, alpha-1-antitrypsin deficiency, tyrosinemia, Wilson's disease, and chronic active hepatitis. Prospective recipients are evaluated with regard to growth and nutrition, hepatic encephalopathy, and metabolic disease. The MELD system adapted for the pediatric population, PELD assesses 1) age at listing, 2) albumin, 3) bilirubin, 4) INR, and 5) growth failure based on gender, height, and weight. Preoperative management includes medical therapy to correct metabolic abnormalities, correction of malnutrition, delivery of normal "well child" care, and vaccination. Surgical options include reduced-size liver grafts, split, and living-related grafts. In the early postoperative period, small children and infants are particularly liable to develop vascular problems and bile leaks.

Key Words: liver transplantation • biliary atresia • Crigler-Najjar syndrome

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