Pediatric Liver Transplantation

The history of pediatric liver transplantation started with the first unsuccessful liver transplantation in 1963. In the late 1960s, eight pediatric patients survived the initial transplantation, only to face difficulties with immunosuppression. The introduction of cyclosporine A in 1978 made acceptable long-term survival rates possible [1], and liver transplantation became standard of care in the 1980s for liver failure and end-stage liver disease. The resulting shortage of organs for small children triggered surgical innovations in the late 1980s and early 1990s such as living-donor liver and split liver donations. The introduction of the pediatric end-stage liver disease (PELD) score in 2002 shifted wait-list priority for organ allocation from time on the waiting list to the severity of the disease. This evolution over almost 50 years leads to today’s excellent long-term outcome after pediatric liver transplantation with 1- and 5-year survival rates of 90 % and 85 %, respectively [2]. Problems related to lifelong immunosuppression and donor scarcity are remaining challenges.