TY - JOUR T1 - Diagnosis and management of late complications after liver transplantation JF - Archives of Disease in Childhood JO - Arch Dis Child SP - 446 LP - 451 DO - 10.1136/adc.81.5.446 VL - 81 IS - 5 AU - Gabi Noble-Jamieson AU - Nick Barnes Y1 - 1999/11/01 UR - http://adc.bmj.com/content/81/5/446.abstract N2 - Liver transplantation is the only effective treatment for end stage liver disease. In recent years the results of this major procedure have improved progressively in adults and children.1-4 At Addenbrooke’s Hospital, Cambridge, the children’s liver transplantation programme was started in January 1984. By December 1996, 200 children had received 284 liver grafts. In December 1998, 138 (69%) of these children were alive more than two years after their first liver graft, 120 were alive after more than five years, and 37 were alive after more than 10 years. In the past 10 years the one year survival rate has increased to 87%. After a successful transplant, children can return to full health and activity, with normal growth and development, but have to continue lifelong immunosuppression.Liver transplantation remains a difficult and dangerous operation. Most of the acute and life threatening problems occur in the first postoperative days and weeks, and therefore during the initial admission, but important later complications develop in as many as one third of children.3 4 As the number of children surviving transplantation has increased, many general paediatricians and general practitioners have become involved in sharing the care of these children with transplant units. It is therefore important that the local medical team is conversant with the potential late complications of transplantation.In this paper we review our own and the reported experience of late complications in children after liver transplantation. Guidelines on preliminary investigation and management are summarised in table 1, and fig 1 illustrates possible sites of biliary and vascular strictures and occlusions.View this table:In this windowIn a new windowTable 1 Medium and late term complications after liver transplantation in children Figure 1 Biliary and vascular complications after liver transplantation. IVC, inferior vena cava. The average hospital stay after liver transplantation is five weeks, but some children who have an uncomplicated course … ER -