Changing definitions of successful outcomes in pediatric liver transplantation.

PURPOSE OF REVIEW: This review highlights the fact that in the current era, the focus of success in pediatric transplantation has moved from short-term to long-term patient and graft survival as well as achieving 'normality' after transplantation.

RECENT FINDINGS: Advances in surgical techniques, organ allocation, intensive care management, laboratory tests, interventional and diagnostic radiology, immunosuppressive, and antiviral drugs have allowed a larger number of pediatric liver transplant recipients to progress into adulthood. To achieve 'normality' several medical and psychosocial factors have become the target of intervention. Attaining optimal linear growth and puberty after transplant is important as is minimizing adverse events associated with immunosuppression. Special considerations are important in the adolescent transplant recipient, particularly adherence to medical recommendations. Liver transplant recipients have been reported to have below average intelligence quotient at school entry and significantly lower health-related quality of life than healthy controls and appropriate interventions need to be put in place early. Successful long-term outcomes in transplantation are contingent on successful transition from pediatric to adult healthcare services. Achieving operational tolerance remains a goal.

SUMMARY: In conclusion, this review outlines the myriad issues around pediatric transplantation that can be addressed so that the transplant recipient may experience a 'normal' quality of life.