Pädiatrische Lebertransplantation

Melter, Michael; Vermehren, Jan; Grothues, Dirk; Knoppke, Birgit

doi:10.1007/s00112-011-2561-9

Cited by 12 publications

(2 citation statements)

References 53 publications

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“…Gubernatis et al reported the first successful case in a patient with acute liver failure. After her recovery, the native liver has regenerated and immunosuppressive treatment could be withdrawn [110,111].…”

Section: Auxiliary Transplantationmentioning

confidence: 99%

Pediatric Liver Transplantation

Wiederkehr¹,

Wiederkehr²,

Wiederkehr³

2016

Frontiers in Transplantology

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Liver transplantation (LT) has become standard management of pediatric liver diseases that lead to acute liver failure or can progress to end-stage liver disease (ESLD). Indications for LT in pediatric patients can be classified into cholestatic disorders, metabolic liver diseases causing liver cirrhosis, metabolic liver diseases without liver cirrhosis, acute liver failure, acute and chronic hepatitis, and liver tumors. The most common indication of PLT is biliary atresia. Generally, the patient is a child with biliary atresia with several prior surgical procedures, extremely malnourished, with stigmata of fat-soluble vitamin deficiency, bleeding diathesis, uncontrolled portal hypertension and massive ascites. Before the technique of liver splitting, pediatric patients were dependent on donors with similar age or size. Partial liver grafts can be obtained either by splitting a cadaveric donor organ or by living-donor liver donation. Living donor liver recipients have a shorter waiting time. The majority of centers employ a regime of' triple therapy with prednisolone, mycophenolate and tacrolimus. LT in the pediatric setting is technically challenging due to the reduced size of the vasculature and biliary tree. Strategies for identification and mitigation of risk factors, prevention of technical complications, and protocols for early detection of vascular complications may reduce mortality, morbidity.

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Section: Auxiliary Transplantationmentioning

confidence: 99%

Pediatric Liver Transplantation

Wiederkehr¹,

Wiederkehr²,

Wiederkehr³

2016

Frontiers in Transplantology

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“…In Germany, approximately 100 children and adolescents undergo liver transplantation due to acute and chronic liver failure every year. The 5‐year survival rate is about 90% 1‐3 . Yet, although the transplantation process exposes children and their families to a multitude of factors that may impede cognitive development, cognitive function is rarely examined.…”

Section: Introductionmentioning

confidence: 99%

Risk factors associated with cognitive impairment in patients after pediatric liver transplantation

Eder

Melter

Gabler

et al. 2020

Pediatric Transplantation

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Data on cognitive function after pLT are rare, particularly regarding children with cognitive impairment. From 2016 to 2018, we evaluated cognitive function in 36 patients after pLT aged 6‐17 years with the WISC IV (at least 1 year after transplantation) and analyzed potential risk factors for cognitive impairment (IQ < 70) by means of retrospective medical data (peri‐, intra‐, and post‐operative factors, and donor and specific organ data of the primary liver transplant) on an exploratory base. At a median age of 9.6 years (range = 6‐16.9), 22% of patients were cognitive impaired (IQ < 70; including five untestable patients with severe cognitive impairment). Children tested with the WISC IV scored within the lower normal range but differed significantly from normal population. Strongest associations showed infections at pLT, development of severe sepsis requiring intensive care within the first 6 months after pLT, neurological complications within the first 10 days and the occurrence of CPR during or after pLT, and as early laboratory variables pH value on day 0 after pLT. In our analysis, neither intraoperative factors nor donor‐specific factors seemed to influence cognitive outcome. In our small cohort, medical complications before and after pLT but not transplantation itself had an influence on cognitive outcome. As such, children experiencing medical problems before and in the early post‐operative phase after pLT should be closely evaluated in larger samples regarding their neurological and psychomotor development during vulnerable phases and should receive early educational support to improve long‐term cognitive function.

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Qualitätsmerkmale und Strukturvoraussetzungen für pädiatrische Lebertransplantationszentren

Melter

Grothues

2013

Pädiatrische Gastroenterologie, Hepatologie Und Ernährung

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Durch die Entwicklung verschiedener, innovativer Operationstechniken vor allem zur Größenadaptation von Lebertransplantaten wurde die Voraussetzung geschaffen, Lebertransplantationen auch bei kleinen Kindern (einschließlich Neugeborenen und Säuglingen) erfolgreich durchzuführen. Auf der Basis der Fortschritte in den operativen Techniken und der Immunsuppression hat sich seit den 1980er Jahren die pädiatrische Lebertransplantation auch in Deutschland zum Standardverfahren bei akutem oder chronischem Leberversagen sowie bei einer Reihe von hepatisch bedingten Stoffwechselerkrankungen etabliert (Ng et al. 2008; Kelly 2006). Aufgrund dieser Fortschritte sowie der Fortschritte im Bereich der pädiatrischen Transplantationshepatologie und der pädiatrischen Intensivmedizin werden heute in spezialisierten pädiatrischen Lebertransplantationszentren bei meist guter Rehabilitation im Vergleich zu Erwachsenenkollektiven vergleichbare 1-Jahres-Überlebensraten (bis zu >90 %), bei deutlich höheren Langzeitüberlebensraten (>90 %) erreicht (Melter 2012). Das Hauptaugenmerk der klinischen Versorgung liegt daher inzwischen darauf, mit einer entsprechenden medizinischen Nachsorge die vor allen Dingen medikamentenassoziierte Morbidität und Letalität im Langzeitverlauf zu minimieren (Ojo et al. 2003).

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Pädiatrische Lebertransplantation

Cited by 12 publications

References 53 publications

Pediatric Liver Transplantation

Pediatric Liver Transplantation

Risk factors associated with cognitive impairment in patients after pediatric liver transplantation

Qualitätsmerkmale und Strukturvoraussetzungen für pädiatrische Lebertransplantationszentren

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