Liver Transplantation in the Neonate and Young Infant

Abstract

After completing this article, readers should be able to: 1. Describe the indications for liver transplantation in neonates and young infants. 2. Delineate major considerations that affect the timing of liver transplantation in young infants. 3. Characterize major medical complications of liver transplantation in young infants and approaches to their treatment. 4. Describe issues unique to the neonate and young infant that affect successful liver transplantation and approaches taken to address these issues. Prior to 1980, liver transplantation in the pediatric age group was characterized by poor outcomes, with high rates of mortality and complications and poor quality of life for the survivors. With improved surgical techniques and immunosuppressive medications, the average survival rate for children has increased to 85% at 1 year and 77% at 5 years after surgery. In addition, complications have become less frequent and are less severe. Because of these advancements, liver transplantation has become standard therapy for life-threatening liver disease in children. Nonetheless, liver transplantation in neonates and young infants remains challenging due to factors such as paucity of donor organs and technical difficulties related to small body size and small graft size. Recent data from United Network of Organ Sharing (UNOS) show that although infants younger than 1 year of age comprise a relatively small group of children waiting on the liver transplant list (<10%), they have the longest waiting times and highest mortality rates while awaiting an organ. This review focuses on the indications, timing, and common complications of liver transplantation pertinent to this high-risk population of children as well as a discussion of recent clinical advances that have resulted in improved outcomes. The most common indications for liver transplantation in the pediatric patient are biliary atresia (43%), metabolic liver disease (13%), and fulminant hepatic failure due to acute hepatic necrosis (11%). Other, less common liver diseases …