Common causes for end stage liver disease in children depend on age but biliary cirrhosis due to extrahepatic biliary atresia, metabolic disorders like Wilson disease, liver resident enzyme defects and autoimmune disorders are more common than viral hepatitis. Almost one fifth of those who need transplantation have acute liver failure.
Most deceased donors being adults, children are rarely able to receive a whole organ. Partial grafts obtained by reducing or splitting a deceased donor organ or a living donor are usually the only grafts available.
Liver disease has a profound impact on physical, psychosocial and intellectual development in children. If liver transplantation is needed it should be performed as early as possible to take advantage of catch-up growth and avoid interference with schooling.
Parents have to be extremely motivated to work in conjunction with the transplant teams to ensure compliance with instruction particularly as the child grows and the baton of responsibility passes on from parents to the child.
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