Indications and Contraindications for Pediatric Liver Transplant

Introduction

Liver transplantation has become the standard of care for children with an array of disease processes. Collectively, progressive hepatic disease with complications of end-stage liver disease (ESLD), metabolic disease with and without hepatic structural involvement, pediatric acute liver failure (PALF), and unresectable hepatic malignancies constitute the majority of current indications for liver transplant in children. Improvement in both patient and graft survival, in addition to advancements in operative techniques aimed at extending the donor pool, has enabled an expansion in disease etiologies and patient populations for which liver transplant can act as a lifesaving intervention and/or provide a more optimal treatment strategy. The aim of this chapter is to review the evolution of liver transplantation and current relative contraindications and focus on novel and controversial indications. Although not an exhaustive list, highlighted later are several of the current etiopathologies pushing the boundaries of liver transplant and continuing the evolutionary process.