What does the long-term liver allograft look like for the pediatric recipient?

1. Histological abnormalities are commonly present in late posttransplant biopsies from pediatric liver allograft recipients. 2. Many of the changes are seen in children who appear to be clinically well with good graft function. 3. In comparison with adults, children may be more prone to developing late rejection (possibly related to noncompliance with immunosuppression) and biliary/vascular complications, but they are much less likely to suffer problems with disease recurrence. 4. De novo autoimmune hepatitis occurs in 5% to 10% of children after transplantation and may represent a hepatitic form of late cellular rejection. Most cases respond to treatment with increased immunosuppression. 5. Recent studies have shown a high frequency of unexplained (idiopathic) chronic hepatitis in late posttransplant biopsies from children. This is associated with the development of graft fibrosis and cirrhosis. 6. Further studies are required to investigate the role of protocol liver biopsies in determining therapeutic strategies in children who appear to have good graft function according to noninvasive investigations.