LAUSR

Liver transplantation (LT) is a lifesaving procedure for select patients with both acute and chronic liver failure. Advancements in surgical techniques, postoperative management, and immunosuppression have resulted in improved shortand longterm outcomes. Approximately 550 pediatric LTs occur each year, accounting for nearly 18,000 LTs performed on recipients younger than 18 years of age to date based on Organ Procurement and Transplantation Network (OPTN) data as of December 2021. Although pediatric LTs account for less than 10% of all LTs in the United States each year, sufficient differences in disease pathophysiology and patient management warrant further consideration and discussion. Disease categories suitable for referral to a pediatric LT program are similar to adults: acute liver failure, autoimmune disease, cholestasis, metabolic or genetic disease, oncologic disease, vascular disease, and infectious disease. It is important to recognize, however, that specific etiologies and outcomes differ widely from adult patients. Early referral for LT evaluation should be anticipated for children with chronic liver disease and evidence of deteriorating liver function characterized by poor weight gain, growth failure, variceal hemorrhage, intractable ascites, recurrent cholangitis or episodes of spontaneous bacterial peritonitis, pruritus, advancing encephalopathy, and/or uncorrectable coagulopathy.[1] Practice guidelines endorsed 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 in 2014[1] can help guide evaluation of the pediatric patient for LT. Indications for pediatric LT based on OPTN/ Scientific Registry of Transplant Recipients data from 2017 through 2019 are illustrated in Figure 1.[2] Presented here is an overview of several pediatric liver diseases that Received: 19 January 2022 | Accepted: 7 March 2022