Paediatric liver transplantation--a review based on 20 years of personal experience.

The natural history of most liver diseases requiring liver replacement in children is well known, and the potential of this therapy has been ascertained regarding life expectancy, which currently exceeds 90% in the long term. The timing of liver transplantation must be anticipated, to reduce the physical, psychological and mental impact of chronic liver diseases. Several studies show evidence that the best long-term results with regard to patient and graft survival are obtained with grafts procured from relatively young donors. Since the shortage of post-mortem liver donors will most likely worsen, further development of live, related-donor transplantation can be expected. The main progress to come will concern immunosuppression, taking advantage of the immunological privilege of the liver. Protocols are under development for induction of operational tolerance.