Pediatric Liver Transplantation 2011

Since more than two decades, liver transplantations have been performed in Germany for acute or chronic liver failure in children and adolescents. Indications vary significantly from those in adults with liver failure. Innovative surgical techniques, such as living-related liver transplantation or split-liver technique, led to a very low mortality on the wait list and to the fact that most children receive a suitable transplant in time. Results following pediatric liver transplantation with regards to morbidity and mortality are excellent today and quality of life is nearly unaffected in the majority of transplanted children. Current clinical and scientific interests focus on optimizing and individualizing immunosuppressive therapy, the phenomenon of chronic transplant failure, and tolerance induction. Furthermore, indications for liver transplantation have been extended to children suffering from selective metabolic diseases, in which alternative conservative treatment options have to be discussed with affected families on a very differentiated and individual basis. In the year of 2010, a total of about 100 pediatric liver transplantations were being performed in too many transplant centers in Germany, which may result in a drop of quality. To date, no criteria or certifications have been established to qualify for a pediatric liver transplant program in Germany. Here, we critically discuss current aspects and possible future options of pediatric liver transplantation.