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The outcome after Transjugular Intrahepatic Portosystemic Shunt (TIPS) for hepatic hydrothorax is closely related to liver dysfunction: a long-term study in 28 patientsThe pediatric liver transplant program at the Université Catholique de Louvain, Cliniques Saint-Luc, Brussels : Overall results in 444 children (1984-1997)

The paediatric liver transplantation program at the Université catholique de Louvain(1). (1) Presented at the Symposium “Liver transplantation and its alternatives in the third millennium”, in honour of professor Jean-Bernard Otte (Brussels,4 October 2

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Acta gastroenterol. belg., 2004, 67, 176-178

April-June Volume 67, fasc. 2

The paediatric liver transplantation program at the Université catholique de Louvain(1). (1) Presented at the Symposium “Liver transplantation and its alternatives in the third millennium”, in honour of professor Jean-Bernard Otte (Brussels,4 October 2002).

R. Reding, C. Bourdeaux, J. Gras,V. Evrard, J.P. Buts, M. Carlier, O. Ciccarelli, P. Clapuyt, S. Clement de Clety, M. De Kock, D. Hermans, M. Janssen, D. Moulin, J. Rahier, C. Saint-Martin, C. Sempoux, L. Van Obbergh, F. Veyckemans, J. Lerut, J. de Ville de Goyet, E. Sokal, J.B. Otte. Paediatric Liver Transplantation Program, Université catholique de Louvain, Saint-Luc university Clinics, Brussels Belgium.

The Paediatric Liver Transplant Program at Saint-Luc University Clinics constitutes a substantial single centre experience, 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 transplantation in children constitutes a considerable undertaking and its results depend on multiple, intermingled risk factors. An analysis 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 diagnosis on survival and of primary immunosuppression on the rejection incidence. The introduction of living related liver transplantation in 1993 not only permitted to provide access to liver replacement 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 avoidance is not harmful, and could even be beneficial for paediatric liver recipients, particularly regarding growth, and that combining 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 tolerance induction, the development of adolescence transplant medicine, and the risk of early atherogenesis in the adulthood.