Liver transplantation and liver cell transplantation |
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| Authors: | Lacaille Florence |
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| Affiliation: | 1. Service d’hépatologie, hôpital Saint-Antoine, 184, rue du faubourg Saint-Antoine, 75012 Paris, France;2. Service de santé publique, hôpital Saint-Antoine, AP–HP, Paris, France;3. Centre de transplantation hépatique, hôpital Saint-Antoine, AP–HP, Paris, France;4. Service d’hépatologie et réanimation hépatodigestive, hôpital Beaujon, AP–HP, Clichy, France;5. Service d’hépato-gastroentérologie, hôpital Henri-Mondor, AP–HP, Créteil, France;6. Service d’anatomie et de cytologie pathologiques, hôpital Saint-Antoine, AP–HP, Paris, France;7. Département d’anatomie pathologique, hôpital Beaujon, AP–HP, Clichy, France;8. Secteur de virologie, service de microbiologie, hôpital Beaujon, AP–HP, Clichy, France;9. UMR S938, faculté de médecine Pierre-et-Marie-Curie, site Saint-Antoine, Paris, France;10. Université Pierre-et-Marie-Curie (UPMC) Paris 6, Paris, France;1. Department of Pediatric Gastroenterology, Hepatology and Nutrition, Reference Center for Rare Digestive Diseases, Intestinal Rehabilitation Center, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France;2. Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France;3. Department of Pathology, Hôpital Necker-Enfants Malades, University of Paris-Descartes, 149 rue de Sèvres, 75015 Paris, France;1. Department of Surgery, Academic Medical Center, Amsterdam, the Netherlands;2. Department of Surgery, University Medical Center, Utrecht, the Netherlands;3. Department of Surgery, Zuyderland Medical Center, Heerlen, the Netherlands;4. Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands;5. Department of Radiotherapy, Academic Medical Center, Amsterdam, the Netherlands;6. Department of Gastroenterology, Academic Medical Center, Amsterdam, the Netherlands;7. Department of Medical Oncology, Academic Medical Center, Amsterdam, the Netherlands;1. Respiratory Division, McGill University Health Centre, 1001 Decarie Blvd, D05.2504 Montreal, Quebec, Canada H4A 3J1;6. Respiratory Division, McGill University Health Centre, Montreal, Quebec, Canada;1. Division of Hematology/Oncology, Boston Children''s Hospital, Harvard Medical School, Boston, MA;2. American University of Beirut Medical Center, Beirut, Lebanon;3. Hematology and Blood Transfusion Unit, Department of Human Pathology, University of Nairobi, Nairobi, Kenya;4. Paediatric Haematology, Evelina London Children''s Hospital, Guy''s and St Thomas'' NHS Foundation Trust, London, United Kingdom;5. Hematology-Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;6. Center for Platelet Research Studies, Division of Hematology/Oncology, Boston Children''s Hospital, Harvard Medical School, Boston, MA;7. Kenya Medical Research Institute, Center for Respiratory Diseases Research, Nairobi, Kenya;8. Department of Pediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda;9. Joint Clinical Research Centre, Kampala, Uganda;10. Department of Pediatrics, Government Medical College Nagpur, Nagpur, India;11. School of Medicine, Lebanese American University, Byblos and Nini Hospital, Tripoli, Lebanon;12. Department of Pediatrics, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashta, India;13. AstraZeneca BioPharmaceuticals R&D, Late-stage Development, Cardiovascular, Renal and Metabolic, Gothenburg, Sweden;14. AstraZeneca BioPharmaceuticals R&D, Clinical Pharmacology and Safety Sciences, Clinical Pharmacology and Quantitative Pharmacology, Cardiovascular, Renal and Metabolic, Gothenburg, Sweden;15. AstraZeneca BioPharmaceuticals R&D, Late-stage Development, Cardiovascular, Renal and Metabolic, Gaithersburg, MD |
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| Abstract: | Liver transplantation is nowadays the recognized treatment of many liver diseases and liver-based metabolic disorders in childhood. The indications are congenital cholestatic diseases, mainly biliary atresia, metabolic disorders and fulminant hepatic failure. Potential candidates have to be evaluated early in a specialized center, as the survival rate is worse if the child is transplanted with end-stage liver failure. The graft is in most cases partial, either a split liver from a deceased donor (the other part going to an adult recipient), or the left lobe or left liver from a living donor. The patient's survival rate is about 80-90% at 1 year, 70-80% at 10 years, and the graft survival rate 60-70% at 10 years. Immuno-suppression depends on a calcineurin inhibitor (cyclosporin or tacrolimus), and either steroids or an induction with a monoclonal antibody against IL2-receptor. Early surgical complications are a non-function of the graft (rare), arterial or portal thrombosis, biliary problems (more frequent with partial grafts), bleeding. Infections with bacteria and fungi are frequent and often severe. CMV infection is prevented, or screened and preemptively treated. EBV infection is frequent and may induce a posttransplant lymphoproliferative disease, that can develop into a lymphoma. Early stages are treated with reduction of immuno-suppression and monoclonal antibodies against CD20. Acute rejection is frequent but usually easily controlled. Chronic rejection may be due to poor compliance. Late graft loss is due to chronic rejection or long-standing biliary complications. Long-term complications are progressive graft fibrosis, renal failure due to drug toxicity (mainly calcineurin inhibitors), and cancers (skin and lymphoma). |
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