儿童肝移植

Pediatric liver transplantation

1963年，ThomasStarzl对一例3岁的胆道闭锁患儿施行了人类临床肝移植的第1次尝试。经过近半个世纪的发展，儿童肝移植在手术技巧、麻醉管理、

Pediatric liver transplantation has long been developed in the western world. Currently, favorable outcomes after liver transplantation have been achieved in pediatric recipi- ents and the postoperative 5-year survival rate reached 80% in western transplantation centers. In the China's Mainland, pediat- ric liver transplantation started quite recently and there is still a big gap compared with western centers. In addition, there is un- balanced development between adult and pediatric recipients due to surgical difficulties and undesirable outcomes following pediat- ric liver transplantation. The operation methods of pediatric liver transplantation include whole liver transplantation, reduced-size liver transplantation, living donor liver transplantation and split liver transplantation. Perioperative complications of pediatric liv- er transplantation mainly include portal vein thrombosis, hepatic artery thrombosis, intra-abdominal bleeding, infections, rejec- tion, bile leakage and biliary strictures. While the long-term complications are infections, post-transplantation lymphoprolifer- ative disorders, acute and chronic rejections caused by poor compliance with immunosuppressive therapy. Perioperative com- plications have been reduced recently thanks to improvement of surgical techniques. With the highly-prolonged survival period, long-term postoperative complications have been playing a signif- icant role in recipients＇ survival rates. Management of long-term follow-up and compliance has been the next focus of pediatric liver transplantation.