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What does the long‐term liver allograft look like for the pediatric recipient?
Author(s) -
Hübscher Stefan
Publication year - 2009
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.21902
Subject(s) - medicine , immunosuppression , liver transplantation , cirrhosis , fibrosis , disease , autoimmune hepatitis , hepatitis , transplantation , liver disease , pathology , gastroenterology
Key Points 1. Histological abnormalities are commonly present in late posttransplant biopsies from pediatric liver allograft recipients. 2. Many of the changes are seen in children who appear to be clinically well with good graft function. 3. In comparison with adults, children may be more prone to developing late rejection (possibly related to noncompliance with immunosuppression) and biliary/vascular complications, but they are much less likely to suffer problems with disease recurrence. 4. De novo autoimmune hepatitis occurs in 5% to 10% of children after transplantation and may represent a hepatitic form of late cellular rejection. Most cases respond to treatment with increased immunosuppression. 5. Recent studies have shown a high frequency of unexplained (idiopathic) chronic hepatitis in late posttransplant biopsies from children. This is associated with the development of graft fibrosis and cirrhosis. 6. Further studies are required to investigate the role of protocol liver biopsies in determining therapeutic strategies in children who appear to have good graft function according to noninvasive investigations. Liver Transpl 15:S19–S24, 2009. © 2009 AASLD.