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Clinical Pediatrics
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*Liver Transplantation
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Pediatric Liver Transplantation

History, Recent Innovations, and Outlook for the Future

Samuel A. Kocoshis, M.D.

Department of Pediatrics, University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh, One Children's Place, 3705 Fifth Avenue at DeSoto Street, Pittsburgh, PA 15213-2583

Andreas Tzakis, M.D.

Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh Transplant Institute, Pittsburgh, Pennsylvania

Satoru Todo, M.D.

Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh Transplant Institute, Pittsburgh, Pennsylvania

Jorge Reyes, M.D.

Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh Transplant Institute, Pittsburgh, Pennsylvania

Bakr Nour, M.D.

Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh Transplant Institute, Pittsburgh, Pennsylvania

Pediatric liver transplantation has advanced remarkably over the past three decades. One-year survival has progressively increased to nearly 90% in patients transplanted for most forms of liver disease. Parallel advances in organ procurement, operative technique, immunosuppression, and infection control are responsible for improved patient survival. Among the most important advances are use of the University of Wisconsin (UW) organ preservation solution, the employment ofvenovenous bypass and/or "piggyback" operative technique, the development of cyclosporine A (CyA) and FK506, and the emergence of acyclovir, ganciclovir, foscarnet, and alpha interferon to combat life-threatening viral infections. The current organ shortage is being addressed by "cutdown" liver transplantation, "split liver" transplantation, and living-related donations. The next decade is likely to see advances in multivisceral transplantation, induction of chimerism by simultaneous bone marrow-solid organ transplantation, and performance of cross-species xenografting.

Clinical Pediatrics, Vol. 32, No. 7, 386-392 (1993)
DOI: 10.1177/000992289303200701
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