The outcomes from pediatric liver transplantation have improved dramatically since its introduction as a lifesaving procedure in the 1980s; however, it remains a complex and demanding surgery, and while it cures chronic liver disease, it creates a variety of new risks associated with the procedure itself and the lifelong need for immunosuppression. Ensuring the best outcomes following liver transplantation requires that transplant professionals closely monitor patients, beginning long before transplant becomes necessary, in order to recognize indications for transplantation, facilitate timely transplant, and minimize the risk of perioperative complications. Particular attention to optimizing nutritional status, recognizing and mitigating cardiac complications associated with liver disease (high cardiac output failure associated with low systemic vascular resistance, diastolic abnormalities, hepatopulmonary syndrome, and portopulmonary hypertension), and aggressive planning to maximize vaccinations and prevent infectious complications is essential to long-term posttransplant health and well-being.
KeywordsNutritional failure Cardiopulmonary complications Cirrhotic cardiomyopathy Immunizations Frailty Infectious risk
- Cystic Fibrosis Foundation. Cystic Fibrosis Foundation Patient Registry 2013 Annual data report. Bethesda.Google Scholar
- Desai MS, Zainuer S, Kennedy C et al (2011) Cardiac structural and functional alterations in infants and children with biliary atresia, listed for liver transplantation. Gastroenterology 141:1264–1272,1272 e1–e4Google Scholar
- Squires RH, Ng V, Romero R et al (2014) Evaluation of the pediatric patient for liver transplantation: 2014 practice guideline by the American Association for the Study of Liver Diseases, American Society of Transplantation and the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 59:112–131CrossRefPubMedGoogle Scholar