Steatosis and fibrosis in paediatric liver transplant: insidious graft's enemies--a call for clinical studies and research.

摘要

Within two decades, liver transplant has become a safe procedure for children with end-stage liver disease of any cause. A combination of both medical and surgical advances, including patient selection, improved peri-operative care, and availability of new immunosuppressive agents, has significantly improved overall survival after transplantation that currently exceeds, in experienced centres, 90% and 85% rates at one and five yr, respectively (1, 2). Long-term outcome is still compromised by delayed and chronic graft damage and by the late adverse effects of immunosuppressive agents, as for example renal dysfunction or increased risk to develop cancer (3). During the last decade, the focus has mostly been on the immunological monitoring and immune system modulation, with prevention of early rejection and induction of operational tolerance being the centre of all interests.