Advances and challenges in pediatric liver transplantation: Global perspectives and the Japanese experience

Pediatric organ transplantation has evolved significantly since the 1950s, with breakthroughs in immunosuppressive therapy in the 1980s.Worldwide, around 2,700 pediatric liver transplants are performed annually, with living donor transplants dominating in Japan due to cultural and legal limitations surrounding brain-dead organ donation.Regional disparities in transplant practices are evident, with braindead transplants being more common in North America and Europe, while living donor transplants prevail in Asia and the Middle East.Technological innovations such as machine perfusion and minimally invasive surgery have enhanced transplant outcomes and addressed the ongoing donor shortage.Despite excellent long-term survival rates, challenges persist, particularly with graft fibrosis, which affects over 60% of pediatric recipients within a decade post-transplant.A critical issue is the transition of pediatric transplant patients to adult care facilities, where nonadherence with immunosuppressive regimens is associated with a high mortality rate.As the number of pediatric transplant cases rises, the need for increased human and financial support becomes more pressing to ensure these patients receive comprehensive care throughout their lives.