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Hepatitis C in the pediatric population: Transmission, natural history, treatment and liver transplantation

World Journal of Gastroenterology 2014年第32期20卷 11281-11286页

作者： Saira Khaderi ross shepherd John A Goss Daniel Leung Division of Abdominal Transplantation Micheal E DeBakey Department of Surgery Baylor College of Medicine Houston TX 77030 United States Division of Pediatric Gastroenterology Hepatology Nutrition Texas Children’s Hospital Baylor College of Medicine Houston TX 77030 United States

The number of children affected by the hepatitis C virus (HCV) in the United States is estimated to be between 23000 to 46000. The projected medical cost for children with HCV in the United States is upwards of 200 million over the next decade. The implementation of routine screening of blood supply has virtually eliminated transmission via transfusion and vertical transmission is now the most common mode of infection in children. Infections acquired during infancy are more likely to spontaneously resolve and fibrosis of the liver tends to increase with age suggesting slow progressive histologic injury. Anti-viral treatment may be warranted in children with persistently elevated liver enzymes or with significant fibrosis on liver biopsy. Current standard of care includes weekly pegylated interferon and ribavirin twice daily. Predictors of high sustained viral response include genotype 2 and 3 and low viral load in children with genotype 1 ( 90%). Only 34 pediatric patients were transplanted with hepatitis C between January 2008 and April 2013. The majority of pediatric patients were born prior to universal screening of blood products and, as of June 2013, there are only two pediatric patients awaiting liver transplantation for end-stage liver disease secondary to hepatitis C. Pediatric survival rates post-transplant are excellent but graft survival is noticeably reduced compared to adults (73.73% for pediatric patients at one year compared to 87.69% in adult patients). New safe potent, and all-oral effective antiviral therapies for recurrent HCV should help increase graft survival.

关键词： Hepatitis C Liver transplantation Pediatric Infection Fibrosis Liver disease

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Beyond the Pediatric end-stage liver disease system: Solutions for infants with biliary atresia requiring liver transplant

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World Journal of Gastroenterology 2014年第32期20卷 11062-11068页

作者： Mary Elizabeth M Tessier Sanjiv Harpavat ross W shepherd Girish S Hiremath Mary L Brandt Amy Fisher John A Goss Department of Pediatrics Baylor College of Medicine and Texas Children’s Hospital Department of Pediatrics Baylor College of Medicine and Texas Children’s Hospital Houston Department of Surgery Baylor College of Medicine and Texas Children’s HospitalHouston

Biliary atresia(BA), a chronic progressive cholestatic disease of infants, is the leading cause for liver transplant in children, especially in patients under two years of age. BA can be successfully treated with the Kasai portoenterostomy; however most patients still require a liver transplant, with up to one half of BA children needing a transplant by age two. In the current pediatric end-stage liver disease system, children with BA face the risk of not receiving a liver in a safe and timely manner. In this review, we discuss a number of possible solutions to help these children. We focus on two general approaches:(1) preventing/delaying need for transplantation, by optimizing the success of the Kasai operation; and(2) expediting transplantation when needed, by performing techniques other than the standard deceased-donor, whole, ABO-matched organ transplant.

关键词： Biliary atresia Liver transplantation Pediatric liver disease Pediatric end-stage liver disease Kasai operation Newborn screening Surgical outcomes Living-related donor transplantation Split liver transplantation ABO-incompatible liver transplantation

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