Pediatric Liver Transplantation

A Clinical Guide

1st Edition - December 11, 2020
Authors: Nedim Hadzic, Ulrich Baumann, Valérie MCLIN
Language: English
Hardback ISBN:
9 7 8 - 0 - 3 2 3 - 6 3 6 7 1 - 1

Written and edited by global leaders in the field, Pediatric Liver Transplantation: A Clinical Guide covers all aspects of treatment and management regarding this multifaceted… Read more

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Written and edited by global leaders in the field, Pediatric Liver Transplantation: A Clinical Guide covers all aspects of treatment and management regarding this multifaceted procedure and unique patient population. This practical reference offers detailed, focused guidance in a highly templated, easy-to-consult format, covering everything from pre-transplantation preparation to surgical techniques to post-operative complications.

Cover image
Title page
Table of Contents
Copyright
Dedication
Preface
List of Contributors
Section 1: Evolution of Transplantation Medicine
1: Brief History of Pediatric Liver Transplantation
Abstract
Principal Historical Milestones and Breakthroughs
New Challenges
Historical Milestones
2: What Is Different Between Pediatric and Adult Liver Transplantation?
Abstract
Introduction
Pediatric Hepatology
Organ Donation
Liver Transplantation Procedure
Post-transplantation Care and Complications
Outcomes and Quality of Life
Section 2: Setting for PLT
3: Health System Requirements for Pediatric Liver Transplantation
Abstract
Introduction
Team
Referral and Candidate Selection
Waitlist
Immediate Pre- and Post-transplant Period
Long-Term Follow-Up
Conclusion/Summary
4: Managing a Scarce Resource in Pediatric Liver Transplantation
Abstract
Introduction
5: Indications and Contraindications for Pediatric Liver Transplant
Abstract
Introduction
Evolution
Controversial Indications
Relative and Absolute Contraindications
Summary
Section 3: Preparation for PLT
6: Preparation for Pediatric Liver Transplant: Medical Aspects
Abstract
Introduction
Hepatology
Nutrition
Infectious disease
Immunization
Cardiology
Pulmonary
Nephrology
Endocrinology
Neurological
Hematology
Oncology
Other Systems
Conclusion
7: Psychological/Social Aspects
Abstract
Illness Phase
Transplant Phase
Living Donor Liver Transplantation
Transplantation Education
Conclusion
8: Living Donor Liver Transplantation in Children
Abstract
Introduction
Living Donor Selection and Workup
Presurgical Evaluation of Recipients
Surgical Technique
Outcome
Perspectives/Conclusion
9: ABO Incompatibility: Indications and Management
Abstract
Introduction
Basic Pathophysiology and Pathological Findings
Strategies to Overcome ABO Incompatibility in Liver Transplantation
Procedures Aimed at B-Cell Depletion
Procedures Resulting in the Inhibition of Antibody Production: Intravenous Immunoglobulins
Procedures Eliminating Anti-A/B Antibodies
Graft Local Infusion Therapy
Perioperative Strategies in ABOi Liver Transplantation
Summary
Section 4: Combined Transplant Options
10: Liver and Hematopoietic Stem Cell Transplantation
Abstract
Liver and Hemopoietic Stem Cell Transplantation for Achieving Immunological Tolerance
Liver and Hemopoietic Stem Cell Transplantation for Primary Immune Deficiencies
Hematopoietic Stem Cell Transplantation for Aplastic Anemia After Liver Transplantation
Controversial Indications for Liver and Hemopoietic Stem Cell Transplantation
Hematopoietic Stem Cell Transplantation for Autoimmune Liver Disease
11: Combined Liver and Kidney Transplantation
Indications
Timing of Transplantation
Surgical Considerations and Graft Selection
Operative and Post-operative Medical Management
Immunosuppression
Transplantation Surveillance: Monitoring and Management
Outcome
Summary
12: Combined Transplantation Liver-Heart, Lung, and/or Pancreas
Abstract
13: Combined Liver and Small Bowel Transplantation
Abstract
Introduction
Indications
Timing of Transplantation
Surgical Considerations and Graft Selection
Post-operative Management
Intestinal Transplantation Surveillance: Monitoring and Management
Results, Follow-Up, and Quality of Life
Conclusion
Section 5: Operation
14: The Transplant Procedure: Surgical Aspects and Techniques
Abstract
Introduction
Historical Background
Pediatric Liver Transplantation: Graft Types
Operative Considerations
Managing Surgical Complications
Conclusion
15: Anesthetic Aspects
Abstract
Introduction
Anesthesia Assessment for Potential Transplant Candidates
Standard Anesthesia Technique
Special Cases
Conclusion
16: Post-Operative Care After Liver Transplantation
Abstract
Introduction
Post-Operative Monitoring and General Management
Post-Operative Analgesia
Primary Non-Function of the Graft
Abdominal Compartment Syndrome
Post-Operative Vasoplegia
Post-Operative Bacterial Sepsis and Septic Shock
Section 6: Medical Management
17: Types of Rejection
Abstract
Immunological Mechanisms of Rejection
The Liver as a “Privileged” Organ
Immunoresponsiveness of Children
Principles of the Diagnosis of Rejection
Acute Cell-Mediated Rejection
Chronic Rejection
Antibody-Mediated Rejection
Donor-Specific Antibodies Affecting Long-Term Outcome
Monitoring for Donor-Specific Antibodies: Pre-Transplantation and Post-Transplantation
Conclusion
18: Anti-rejection Strategies
Abstract
Introduction
Induction of Anti-rejection
Calcineurin Inhibitors
Corticosteroids
Other Drugs and Renal Sparing
ABO-Incompatible Donor
Retransplantation and Tailor-Made Approaches
Steroid-Resistant Rejection
New Strategies and the Future
19: Anti-infection Strategies
Abstract
Anti-infection Strategies
Viruses
Bacteria
Fungi
Conclusion
Section 7: Early Postoperative Complications
20: Early Vascular Complications
Abstract
General Considerations
Early Hepatic Artery Complications
Early Portal Vein Complications
Early Hepatic Vein Complications
Anti-coagulation in Pediatric Liver Transplantation
Hemorrhage
Conclusions
21: Biliary Complications in Pediatric Liver Transplantation
Abstract
Introduction
Risk Factors
Clinical Presentation and Diagnosis
Treatment
22: General Aspects of Early Management
Abstract
Introduction
The Clavien-Dindo Classification
Drain Losses After Liver Transplantation
Small-for-size Syndrome
Large-for-size Syndrome
Calcineurin Inhibitor Metabolism
Transplant-Acquired Disease
Conclusion
23: Hematologic Complications After Liver Transplant
Abstract
Introduction
Early Anemia
Passenger Lymphocyte Syndrome
Aplastic Anemia
Autoimmune Cytopenias
Hemophagocytic Lymphohistiocytosis
Summary
24: Role of Histology Following Pediatric Liver Transplantation
Abstract
Introduction
Practical Considerations
Histopathology of the Recipient Liver
Post-Reperfusion Biopsies
Technical Complications
Immunological Complications
Complications of Immunosuppression
Late-Allograft Biopsies
Section 8: Late Postoperative Complications
25: Surgical Complications
Abstract
Introduction
Late Vascular Problems
Unusual Causes of Surgical Abdominal Problems After a Transplantation
Graft Remodeling
26: Recurrence of Disease After Liver Transplantation
Abstract
Autoimmune Liver Disease
Progressive Familial Intrahepatic Cholestasis Type 2
Post-transplantation Complications of Specific Rare Conditions
27: Immunological and Other Late Complications
Abstract
Immune-Mediated Disorders
Nonimmune-Mediated Complications of Chronic Immunosuppression
28: Post-transplant Lymphoproliferative Disease
Abstract
Introduction
Pathogenesis
Histopathological Classification
Incidence and Risk Factors in Pediatric Liver Transplantation
Diagnosis
Treatment
Prognosis
Potential Complications and Long-Term Care
Prevention and Early Detection of Post-transplant Lymphoproliferative Disease
Special Considerations
29: Role of Radiology and Interventional Radiology After Pediatric Liver Transplantation
Abstract
Diagnosis of Complications: Role of Imaging Modalities
Interventional Radiology for Diagnosis, Treatment, and Outcome
Conclusion
30: Role of Biomarkers in Monitoring Liver Allograft Function
Abstract
Introduction
Graft Fibrosis
Serological Markers
Imaging Techniques
Section 9: Complementary Clinical Options to PLT
31: Liver Assist Systems in Pediatric Liver Failure
Abstract
Introduction
Indications for an Extracorporeal Liver Support System
Artificial Liver Support
Safety of Albumin Dialysis
Efficacy of Albumin Dialysis in Pediatrics
Efficacy of Plasmapheresis—Adult and Pediatric Data
Bioartificial Liver Support
32: Cell Transplantation
Abstract
Introduction
Hepatocyte Transplantation
Stem and Progenitor Cell-Based Cell Transplantation
Remaining Challenges and Conclusion
33: Gene Therapy
Abstract
Introduction
Why Gene Therapy? What Is the Advantage Compared With Liver Transplantation? Pros and Cons for Liver Transplantation and Gene Therapy
The Clinical Experience With Liver Gene Transfer
Delivery Tools (Vectors) With Advantages and Disadvantages for Each
Advantages and Disadvantages of Different Gene Therapy Approaches (Gene Repair, Gene Addition, Gene Editing, Homologous Recombination, Nucleases, Promotorless)
Disease-Specific Aspects and Milestones
Current Challenges of In Vivo Gene Transfer With Adeno-Associated Virus Vectors
Conclusions
Section 10: Chronic Management in Specific Indications
34: Biliary Atresia
Abstract
Introduction
Kasai Portoenterostomy
Liver Transplantation
Considerations While Awaiting Liver Transplantation
Technical Considerations for Transplantation in Biliary Atresia
Long-Term Biliary Atresia Care
Controversial Topics
Future Considerations
35: Alagille Syndrome
Abstract
Introduction
Growth and Nutrition
Cardiac Involvement
Renal Involvement
Vascular Involvement
Bleeding Risk
Living Related Transplantation
Liver Transplantation Outcomes
Conclusion
36: Liver Transplantation for Acute Liver Failure in Children
Abstract
Etiology of Pediatric Acute Liver Failure
Diagnostic Procedures Necessary to Prepare for Liver Transplantation
General Management Awaiting Liver Transplantation
Disease-Specific Treatment
Liver Support Devices
Indication and Timing for Liver Transplantation
Selection of Donors
Contraindication to Liver Transplantation
37: Auxiliary Liver Transplantation for Acute Liver Failure in Children
Abstract
Introduction
Current Guide to Listing Criteria for Liver Transplant in Acute Liver Failure in Children
Liver Regeneration
Auxiliary Partial Orthotopic Liver Transplant
History of Auxiliary Liver Transplantation
Heterotopic Auxiliary Transplantation for Acute Liver Failure
Auxiliary Liver Transplantation for Acute Liver Failure: Early Results
Patient Selection
Recipient Selection
Donor Selection
Implantation Techniques
Portal Flow Changes After Auxiliary Partial Orthotopic Liver Transplantation for Acute Liver Failure
Post-operative Management
Complications
Auxiliary Liver Transplantation for Acute Liver Failure: Later Results
King’s College Hospital Auxiliary Liver Transplantation for Acute Liver Failure Outcomes
Conclusions
38: Liver Transplantation for Liver Tumors in Children
Introduction
Hepatoblastoma
Hepatocellular Carcinoma
Sarcomas
Vascular Tumors
Histiocytic Disorders
39: Metabolic Conditions
Abstract
Category 1: Intrinsic Liver Disease With Defect Confined to the Liver
Category 2: Intrinsic Liver Disease With an Extrahepatic Defect
Category 3: No Intrinsic Liver Disease With Defect Confined to Liver
Category 4: No Liver Disease and Extrahepatic Defect
Domino Transplantation
Living Donor Liver Transplantation
Auxiliary Liver Transplantation
40: Liver Retransplantation
Abstract
Incidence and Indications—Early and Late Liver Retransplantation
Contraindications for Pediatric Liver Retransplantation
Further Considerations
41: Pediatric Liver Transplantation in Asia
Abstract
Introduction
Liver Transplantation in Japan
Pediatric Liver Transplantation in Other Asian Countries
Perspectives in Asia
Abbreviations
42: Pediatric Liver Transplantation in South America: Incidence and Indications
Abstract
Introduction
Liver Transplantation and Liver Transplantation Centers in South America
Liver Transplantation in Various South American Countries
Indications for Liver Transplantation
Conclusion
Section 11: Long-Term Issues
43: Psychosocial Outcomes After Pediatric Liver Transplantation
Abstract
Introduction
Assessment of Psychosocial Aspects After Pediatric Liver Transplantation
Health-Related Quality of Life
Mental Health
Neurodevelopmental Outcomes
School Performance
Family Functioning
Medication Adherence
Transition to Adult Care
Future Research Recommendations
Conclusion
44: Chronic Graft Injury
Abstract
Introduction
Natural History of Chronic Graft Injury
Histological Patterns of Chronic Graft Injury
Differential Diagnoses of Chronic Graft Injury
Diagnostic and Surveillance of Chronic Graft Injury
Chronic Graft Injury: Etiology Still Unclear?
Therapeutic Approach
Conclusion and Further Concepts
45: Prospects for Immune Tolerance
Abstract
Introduction
The Liver and the Immune System
Consequences for Clinical Practice
Induction of Transplantation Tolerance
Practical Considerations
46: Challenges for Young People With Liver Disease Including Transition to Adult Services
Abstract
Adolescent Development
Challenges for Adolescents
Multidisciplinary Support and Healthcare Provision for Young People
Conclusion
47: Future of Liver Transplantation in Children
Abstract
Introduction
Organ Donation
Organ Preservation and the Advent of Machine Perfusion
Surgical Techniques
Laparoscopic and Robotic Surgery
Anatomical Models in Surgical Training
Selection of Patients and Timing of Transplant
Repopulating Livers After Transplantation
Medical Management
Immunosuppression
Long-Term Survival and a Natural Life Span
Equality of Access to Health Care
The Long Term
Index

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