The paediatric liver transplantation program at the Université catholique de Louvain (1)

The Paediatric Liver Transplant Program at Saint-Luc University Clinics constitutes a substantial single centre experi- ence, including 667 transplantations performed between March 1984 and April 2003, and the history of this program reflects the tremendous progress in this field since twenty years. Liver trans- plantation in children constitutes a considerable undertaking and its results depend on multiple, intermingled risk factors. An analy- sis of the respective impact of several surgical and immunological parameters on patient/graft outcome and allograft rejection after paediatric liver transplantation showed a significant learning curve effect as well as the respective impact of pre-transplant diag- nosis on survival and of primary immunosuppression on the rejec- tion incidence. The introduction of living related liver transplan- tation in 1993 not only permitted to provide access to liver replace- ment in as many as 74% more candidate recipients, but also resulted in better graft survival and reduced retransplantation rate. The results of a recent pilot study suggest that steroid avoid- ance is not harmful, and could even be beneficial for paediatric liver recipients, particularly regarding growth, and that combin- ing tacrolimus with basiliximab (anti-CD25 chimeric monoclonal antibody) for steroid substitution appears to constitute a safe alternative in this context. The long-term issues represent the main future challenges in the field, including the possibility of a full rehabilitation through immunosuppression withdrawal and toler- ance induction, the development of adolescence transplant medi- cine, and the risk of early atherogenesis in the adulthood. (Acta gastroenterol. belg., 2004, 67, 176-178).