Despite medical advances, children receiving liver transplants wait longer than a ...( gical and medical perspective. Newborns...),Health

gical and medical perspective. Newborns tend to have either neonatal liver failure or true acute liver failure that develops immediately after birth. "Supportive care for these children is technically very difficult due to their small size and it is not surprising that these children have a high waitlist mortality," they state. In recent years, improved post-transplant survival has resulted in expanding indications for liver transplants in children. However, the authors advise caution regarding this practice, noting that pediatric transplants are often tied into adult programs, despite the fact the overall numbers of transplants in children have remained unchanged. "Typically, it is not economical to maintain programs that have low annual volume and as such there will be pressure to increase volume at all of these programs," the authors note, adding that this presents a potential conflict of interest to those providing care. Finally, one of the biggest challenges in pediatric liver transplants lies in the fact that the number of adult transplants has increased significantly in recent years, and children and adults potentially compete for the same organs. Noting that this problem may become critical, the authors conclude: "Split rather than reduced-size liver transplantation should be strongly encouraged as it allows children and adults to share rather than compete for livers from adult donors."

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Contact: David Greenberg
dgreenbe@wiley.com
201-748-6484
John Wiley & Sons, Inc.
4-Apr-2006

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