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Liver Transplantation - part 10

Các lợi thế trẻ em đã được cấp để đáp ứng mối quan tâm rằng số lượng nhỏ của trẻ em chờ đợi để cấy ghép gan sẽ được tràn ngập bởi số lượng lớn các người lớn với số điểm tương đương cao hơn, gây ra sự gia tăng tử vong và thời gian chờ đợi dài. | 110 Liver Transplantation advantages for pediatric recipients. The pediatric advantages were granted in response to concern that the small number of children waiting for liver transplant would be overwhelmed by the huge number of adults with equivalent higher scores causing increases in deaths and lengthy waiting times. Lengthy waiting time has a disproportionate negative effect on young infants and children due to the impact of chronic liver disease on physical cognitive and social development. For these reasons pediatric donors donors under 18 years of age are offered to pediatric recipients at an equivalent status or score before potential adult recipients. Furthermore standard UNOS exceptions exist for specific metabolic diseases and additional exceptions may be granted by the regional review boards of UNOS on request. Pre-Operative Management 10 Medical therapy to correct metabolic abnormalities coagulopathy ascites vitamin Deficiencies and malnutrition as much as is possible is a critical part of the management of any child with liver disease. Malnutrition requires special attention as optimization of nutrition protects brain development prior to transplant and also improves outcome after surgery. Nutritional support can start with institution of a high-density caloric diet but often infants and young children require supplemental tube feedings. The choice of formula is important a partially hydrolyzed protein formula with increased medium-chain triglycerides is generally selected to optimize absorption in the face of cholestasis. Meticulous attention to the delivery of normal well-child care is crucial. Vaccination children awaiting liver transplantation should receive all standard immunizations Polio DPT HIB HBV MMR Varicella with particular attention given to live virus vaccines which are generally not administered to immunosuppressed individuals . Furthermore additional vaccinations pneumococcus influenza etc. are generally indicated. Serologic evaluation