Pediatric Gastroenterologist and the Infant and Child Before Liver and Small Bowel Transplantation
Pediatric liver transplantation is the standard of care for children with acute liver failure or end-stage liver disease and has excellent outcomes with 5-year survival rates greater than 85%. The most common cause for liver transplantation in children is biliary atresia unlike in adults where end-stage liver disease is most commonly due to nonalcoholic steatohepatitis (NASH). Similarly, intestinal transplantation is offered to those children with intestinal failure who were unable to achieve intestinal rehabilitation or who were born with congenital/inherited diseases such as microvillus inclusion disease. Three-year survival rates with pediatric intestinal transplantation are greater than 65%. The role of the pediatric gastroenterologist/hepatologist is in the early recognition of children who meet the criteria for transplantation and refer them to an appropriate transplantation center for assessment and evaluation. Pediatric gastroenterologists/hepatologists work in a team setting with pediatric surgeons/transplant surgeons, nutritionists, social work, other pediatric providers and nursing to provide children who are awaiting transplantation optimization of their clinical status and to prevent or treat complications associated with end-stage liver disease or intestinal failure which play a critical role in posttransplant outcomes. This chapter focuses on these topics in detail.
KeywordsLiver transplantation Small intestinal transplantation Cirrhosis Portal hypertension Intestinal rehabilitation Varices Hepatopulmonary syndrome Portopulmonary syndrome Hepatorenal syndrome Hepatic encephalopathy Ascites Coagulopathy Nutrition PELD MELD
- Kulkarni S, Perez C, Pichardo C et al (2015) Use of Pediatric Health Information System database to study the trends in the incidence, management, etiology, and outcomes due to pediatric acute liver failure in the United States from 2008–2013. Pediatr Transplant 19(8):888–895CrossRefPubMedGoogle Scholar
- Squires RH, Ng V, al RR (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(1):112–131CrossRefPubMedGoogle Scholar
- Wieman RA, Balistreri WF (2007) Nutritioinal support in children with liver disease. In: Baker RD, Baker SS, Davis AM (eds) Pediatric nutritioni support. Jones and Bartlett Publishers, Sudbury, pp 459–476Google Scholar