Liver Transplants: What Have We Learned?
Liver Transplants: What Have We Learned?
Source: Talbot D, et al. Progress in pediatric liver transplantationThe Birmingham experience. J Pediatr Surg 1997; 32:710-713.
Talbot and associates summarize their inexperience in Birmingham, England, with more than 200 liver transplants in children over the last 14 years. The authors’ experience parallels that of most centers in this country and is worth reviewing. They point out that several advances have increased the chances that children will be able to benefit from liver transplant. The first is reduction of the size of the donor liver that enables children to receive livers from donors 6-10 times the weight of the recipient. The number of livers available to children has also been increased by the split liver techniques that enable one adult liver to be transplanted into two individuals. The most recent development, which is being increasingly used in this country, has been the living related donor program in which a segment of the liver from a living donor is used to transplant into a child.
In addition to the increased availability of livers for children, Talbot et al point out several areas of advancement in the surgery and management of the transplant that have improved survival of children who receive a liver transplant. These include better management of vascular supply, biliary drainage, and immune suppression. A well-trained and experienced pediatric transplant team should have close to 80% one-year survival for children who receive liver transplants. ach
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