Pediatric liver transplantation

Table 11 Common causes of late dysfunction in the pediatric population

	Incidence at 5 yr (%)	Risk factors
Acute rejection	Variable (< 30)	Inadequate immunosuppression
		Treatment with immune activating drugs (e.g. interferon)
		History of autoimmune liver disease
Chronic rejection	-3	Inadequate immunosuppression
		Treatment with immune-activating drugs (e.g. interferon)
		Refractory acute rejection
		Chronic rejection in a previous failed allograft
Recurrent AIH	-30	Suboptimal immunosuppression
		AIH type I
		Severe inflammation in native liver
		HLA DR3 or DR4
De novo AIH	< 5
Recurrent PBC	20-30	Tacrolimus as baseline immunosuppression
		Living-related donor
		Steroid and other immunosuppression withdrawal
Recurrent PSC	20-30	Male sex; donor-recipient gender mismatch
		Intact colon at time of transplantation
Idiopathic post-transplant hepatitis	5-60

AIH: Autoimmune hepatitis; PBC: Primary biliary cirrhosis; PSC: Primary sclerosing cholangitis.