4. Clinical Guidelines for Liver Transplantation (PDF) - British ...

Guidebook for the Solid Organ Transplant Programme Chapter 4
4.5 Pediatric Transplantation
4.5.1 INTRODUCTION
While the general principles of liver transplantation are similar in children and adults, a number
of additional factors must be considered for the pediatric patient. First, the size of the pediatric
patient may affect the transplant outcome. Candidates weighing less than 10 kg may be at high
risk for transplant complications and the nutritional status of any young patient with liver
disease is a major concern. Second, the immunization status of a child referred for liver
transplant evaluation requires thorough review. Children who are potential transplant candidates
should receive an accelerated immunization schedule whose goal is to complete as many of the
primary immunizations as possible prior to the transplant. Third, the vessels that supply blood
to the liver may be quite small in caliber, especially in young infants. Abnormalities of the
hepatic vasculature are relatively common in children and the risk for post-transplant vessel
blockage is higher for those infants with small caliber vessels. A thorough radiological
assessment of the liver vessels is crucial for the pediatric patient prior to undergoing a liver
transplant. Finally, particular attention must be paid to the child’s environment. The
psychosocial needs of the child, the reliability of the child’s caregivers, the stability of the home
environment and religious or cultural beliefs need to be assessed to ensure adequate and
responsible care of the transplanted child after discharge.
4.5.2 WHEN TO REFER
As part of the liver transplantation protocol, potential pediatric candidates will undergo a
thorough preoperative evaluation of their liver disease to determine their eligibility for
transplantation. We prefer to see potential candidates early in their disease course as this
enables us to anticipate any problems as well as to correct any disease associated complications.
In addition, it affords the transplantation team an opportunity to become familiar with the
patient and their family.
In a child with liver disease, the presence of one or more of the following features indicates
significant hepatic dysfunction and warrants a referral for transplant evaluation:
Progressive jaundice
Diminishing hepatic synthetic function (hypoalbuminemia, coagulopathy unresponsive
to vitamin K, hypoglycemia)
The onset of encephalopathy
Progressive cholestasis/pruritus/refractory cholangitis
Portal hypertension with its complications (variceal bleeding, ascites, hypersplenism)
Growth retardation despite aggressive nutritional therapy
Poor quality of life
Chapter 4 – Clinical Guidelines for Liver Transplantation – July, 2010 Page 27
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