Liver transplantation in children: pre-transplantation preparation tactics

Liver transplantation (LT) from a living related donor is the only life-saving option for children with congenital liver diseases such as biliary atresia, Alagille syndrome, progressive familial intrahepatic cholestasis, and Byler disease, as well as metabolic disorders and acute or chronic liver failure. The development of LT from living related donors significantly reduces the waiting time for a donor organ. The success of the procedure largely depends on the quality of pre-transplantation preparation (PTP) of both donor and recipient. Aim - to study the features of PTP in children with cholestatic liver diseases for successful LT. Materials and methods. 37 children with biliary atresia underwent PTP between 2005 and 2023. In 36 cases, LT was performed using a living related donor; in one case, split-liver transplantation (SPLIT-LT) was used. PTP lasted 3–6 months and included infection focus sanitation, correction of congenital anomalies, emergency status assessment, and evaluation of physical and psycho-emotional development. All examinations followed current international standards. Results. All transplantations were successful. After PTP, improvements were observed in hematological parameters, functional and neuropsychological development, and reduced anxiety levels. All transplant centers acknowledged the high quality of PTP; no child was refused transplantation due to inadequate preparation. The key readiness criteria were a compensated clinical state and a safe bacterial environment. Conclusions. Compliance with regulatory standards and protocols for PTP ensures successful pediatric LT and protects donor health. PTP improves hematological, somatic, and psycho-emotional indicators, reduces risks, and increases the effectiveness of transplantation. Our experience with PTP aligns with international standards. The research was carried out in accordance with the principles of the Declaration of Helsinki. Informed consent of the child and child's parents was obtained for the research. No conflict of interest was declared by the author.