Pediatric Liver Transplantation Under Therapy With Cyclosporin-A and Steroids.

Abstract

During the period 5/9/81 to 5/9/82, 27 consecutive liver transplantations were performed on 23 pediatric patients. Ages ranged from 7.5 months to 18 years. There were 11 males and 12 females. Four patients were adolescents (12–18 years), 6 patients were school age (5–10 years), and 13 were infants to preschools (7.5 months–4.5 years). Follow-up time ranged from 3.5 months to 15.5 months. Survival stands at 70% (16/23), while 61% (14/23) can be described as in excellent condition. Orthotopic liver transplantation (OLT) has, since its inception,1 been a procedure with high mortality and morbidity. Steady improvement in survival statistics have, however, occurred during the 20-year history of the procedure. Improvements in surgical technique, patient selection, and immunosuppression have moved OLT into the realm of practical therapeutics. Pediatric OLT, while always enjoying slightly better survival statistics than its adult counterpart,2 has had added morbidity without correlate in the nonpediatric population. The profound effect of high doses of steroids on the child, which leads not only to growth failure but also to Cushingoid changes, has prompted some to question the use of transplantation in children3 at all. We report improved survival statistics for pediatric OLT under cyclosporin-A (CyA) and low-dose steroids, as well as preliminary data suggesting normal growth velocity posttransplantation in these patients.