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Pediatric Recipients |
Adult Recipient |
| Grafts |
Segmental liver grafts, majority left lateral segments; use more living donor grafts than adults |
Utilizes more whole grafts than segmental |
| Recurrence of
primary disease |
Underlying disease often cured by OLT |
Disease recurrence more prevalent (HCC, HBV, HCV) |
| Medications |
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|
| dosing |
Dosing weight-based |
standard doses |
| formulation |
infants/young children require liquid formulation and compounding; need for specialty pharmacies |
pills, tablets |
| palatability |
problematic in young children, may require enteric tube |
usually not an issue |
| pharmacokinetic |
absorption and bioavailability vary depending on child's age |
no major variability in absorption and bioavailability |
| Compliance |
Dependent on second parties (care givers), cosmetic side effects |
Self-dependent
Lower rejection rates than children |
| (acne, Cushing) often disturbing for teenagers, high non-compliance rate in adolescents, rejection rates higher in children |
| Tolerance |
Higher rates of developing tolerance |
Lower rates of developing tolerance |
| Infections |
Higher risk, if pediatric vaccinations uncompleted; higher risk due to exposure to other children their age |
Vaccinations often completed |
| Growth |
Height below average compared to normal growth curve |
Not an issue |
| Development |
Neurocognitive development can be affected; delayed psychosocial developmental due to isolation related to disease and transplant |
Not an issue |
| PTLD |
Children more likely to be EBV seronegative prior to OLT |
Adult recipients often EBV seropositive prior to OLT |
| Other considerations |
Taking medications and attending appointments during school can be challenging
Missing school and social activities can alienate children and affect education and development |
Adults may have financial considerations with missing work with frequent appointments |
| Phlebotomy/venous access can be more challenging in children
Teenage girls need to be educated and counseled on pregnancy,
teratogenicity of immunosuppressive drugs and contraception |
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| Teenagers need to be educated to be independent and eventually
transitioned to adult care |
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