Pediatric Solid Organ Transplantation: A Practical Handbook

Foreword
Contents
About the Editors
Part I: Renal Transplant
	1: Pediatric Kidney Transplantation: A Historic View
		1.1	 The Triangulation Technique
		1.2	 An Immunologic Barrier
		1.3	 “Science Fiction”: The Beginnings of Human Transplantation
		1.4	 Breaking the Barrier
		1.5	 Youthful Rebellion and Tissue Typing
		1.6	 “It Seemed Too Good to be True”: Pharmacologic Immunosuppression
		1.7	 A Framework for Allocation
		1.8	 “The Greatest Application”: Pediatric Transplantation
		References
	2: Transplant Immunobiology
		2.1	 Introduction
		2.2	 EC Activation Starts before Transplant
		2.3	 The Grafted Organ Comes from an Ischemic Period: Role of the Hypoxic Phase and of Reperfusion
		2.4	 Endothelial Cells Talk with the Immunological System
		2.5	 T and B Cells Are the Main Effectors of Acute Rejection
		2.6	 The Pathways of T Cell Allorecognition
		2.7	 T Cell-Mediated Cytotoxicity
		2.8	 The Costimulatory System
			2.8.1	 The CD28:B7 Family
			2.8.2	 The TNF-Related Family
		2.9	 Adhesion Molecules
		2.10	 B Cells’ Role in Transplantation
		2.11	 Plasma Cells
		2.12	 Cells Participating in the Immune Response: Not Only T and B Cells
		2.13	 Dendritic Cells in Allograft Rejection
			2.13.1	 Which DC: From the Donor’s or the Recipient’s?
		2.14	 Innate Immune Response
		2.15	 Memory Can be Present Also in Non-lymphoid Cells
		2.16	 Tubular Epithelial Cells as Immunoregulator
		2.17	 Extracellular Vesicles Mediate Cellular Cross Talk between Immune System and Graft
		2.18	 Role of Antibodies
			2.18.1	 How Antibodies Damage the Graft
			2.18.2	 Clinical Effects
		2.19	 Role of Complement
		References
	3: Deceased Donor Allocation Policy and Kidney Allocation System on Young Pediatric Recipients
		3.1	 Kidney Transplant’s Impact on Young Pediatric Recipients
		3.2	 Deceased Donors for Pediatric Recipients
			3.2.1	 Ethical Arguments for Pediatric Priority for Deceased Donor Kidney Transplantation
		3.3	 The “Old” and “New” Allocation Systems
			3.3.1	 Share 35
			3.3.2	 Changes in Pediatric Priority under KAS
		3.4	 The KAS Effect on Young Recipients
		3.5	 Eliminating Donation Service Area
		3.6	 Conclusion
		References
	4: Donor-Recipient Size Mismatch in Pediatric Renal Transplantation
		4.1	 Cause of Donor-Recipient Size Mismatch
		4.2	 Overcoming Hemodynamic Imbalance
		4.3	 Surgical Techniques
		4.4	 Graft Survival and Adaptation
		References
	5: Medical Evaluation of the Living Donor for Pediatric Kidney Transplantation
		5.1	 Introduction
		5.2	 Donor Age
		5.3	 Kidney Function
		5.4	 Hypertension
		5.5	 Diabetes and Glucose Abnormalities
		5.6	 Obesity
		5.7	 Proteinuria
		5.8	 Hematuria
		5.9	 Kidney Stones
		5.10	 Malignancy
		5.11	 Screening for Transmissible Infections
		5.12	 Psychological Issues
		5.13	 Conclusion
		References
	6: Surgical Management of the Pediatric Renal Transplant Patient
		6.1	 Introduction
		6.2	 Timing of Transplantation
		6.3	 Donor Selection
		6.4	 The Operation
		6.5	 Incision and Graft Placement
		6.6	 Vessels
		6.7	 Native Nephrectomy
		6.8	 Ureteral Implantation
		6.9	 Postoperative Management
		6.10	 Conclusions
		References
	7: Management of the Pediatric Renal Transplant with Posterior Urethral Valves for Successful Transplantation
		7.1	 Introduction, Epidemiology, and Clinical Presentation
		7.2	 Pathophysiology of Renal Dysfunction in ESRD
		7.3	 Risk Factors for End-Stage Renal Disease in PUV
		7.4	 Preoperative Workup/Evaluation
		References
	8: RISE to Transition: A Structured Transition Protocol for Renal Transplant Recipient
		8.1	 Introduction
		8.2	 Problems of Transition and Consequences of Non-adherence to Transition
		8.3	 Transition Process in Various Studies and Challenges of Transition
		8.4	 Survey of Pediatric Nephrologists and Concern for Transition Process
		8.5	 RISE Protocol
			8.5.1	 Importance of RISE Protocol
			8.5.2	 Transition Age
			8.5.3	 Elements of the RISE Protocol
			8.5.4	 Transition Clinic
			8.5.5	 Transition Team
			8.5.6	 Transition Tools
			8.5.7	 Transition Stages
			8.5.8	 Limitations of RISE Protocol
			8.5.9	 Implementation of RISE Protocol
		8.6	 Conclusion
		References
	9: Induction Therapy in Pediatric Renal Transplant Recipients
		9.1	 Introduction
		9.2	 Aims of Induction Therapy
		9.3	 Historical Induction Agents
		9.4	 Currently Utilized Induction Agents
			9.4.1	 Lymphocyte-Depleting Agents
			9.4.2	 Non-lymphocyte-Depleting Agents
			9.4.3	 Comparison of Antibody Induction Agents
			9.4.4	 Chemical Agents (CNI, Corticosteroids)
		9.5	 Induction Strategies Based on Patient Risk
			9.5.1	 Induction Therapy in Standard-Risk Group
			9.5.2	 Induction Therapy with Steroid Avoidance
			9.5.3	 Induction Therapy in Diseases with a High Risk of Recurrence
				9.5.3.1	 Focal Segmental Glomerulosclerosis (FSGS)
				9.5.3.2	 Atypical Hemolytic Uremic Syndrome (aHUS)
				9.5.3.3	 C3 Glomerulopathy (C3GN)
			9.5.4	 Induction Therapy in Immunologically High-Risk (HLA-Sensitized) Patients
				9.5.4.1	 Intravenous Immunoglobulin: IVIg
				9.5.4.2	 Alemtuzumab
				9.5.4.3	 Antithymocyte Globulin
				9.5.4.4	 Rituximab
				9.5.4.5	 Eculizumab
				9.5.4.6	 C1-INH (Berinert; CSL Behring, King of Prussia, Penn)
				9.5.4.7	 Bortezomib
				9.5.4.8	 Imlifidase
		9.6	 Current Practices in the USA
		9.7	 Conclusions
		References
	10: Maintenance Immunosuppression in Kidney Transplantation
		10.1	 Introduction
		10.2	 Corticosteroids
		10.3	 Calcineurin Inhibitors (CNIs)
		10.4	 Antimetabolite Agents
		10.5	 Mammalian Target of Rapamycin (mTOR) Inhibitor: Sirolimus
		10.6	 Costimulation Blocker: Belatacept
		References
	11: Pediatric ABO-Incompatible Renal Transplant
		11.1	 History of ABOi Renal Transplants
		11.2	 Blood Group Antigens and Blood Group Compatibility
		11.3	 Anti-Blood Group Antibodies and Methods of Determination
		11.4	 Preconditioning Protocol
		11.5	 Accommodation
		11.6	 Significance of Antibody Titer
		11.7	 Outcomes in Children
		11.8	 Unanswered Questions
		11.9	 Conclusions
		Suggested Readings
	12: Overview of Biomarkers of Rejection in Pediatric Renal Transplantation
		12.1	 Invasive Molecular Markers
		12.2	 Noninvasive Biomarkers
		12.3	 Current Challenges
		References
	13: Adherence in Pediatric Transplant Recipients
		13.1	 Introduction
		13.2	 Components of Adherence
		13.3	 Unintentional Vs. Intentional Poor Adherence
		13.4	 Determinants of Adherence
		13.5	 Transfer to Adult-Oriented Care and Adherence
		13.6	 Pretransplant Adherence as a Predictor of Posttransplant Adherence
		13.7	 Methods of Measuring Adherence
		13.8	 Improving Adherence for all Patients
		13.9	 Targeted Intervention
		13.10	 Conclusions
		References
	14: Recent Advances in the Diagnosis and Treatment of Antibody-Mediated Rejection in Pediatric Kidney Transplants
		14.1	 Diagnosis
		14.2	 Detection of Donor-Specific Antibodies
		14.3	 Surveillance DSA Monitoring
		14.4	 Histology
			14.4.1	 Detection of C4d by Immunostaining
		14.5	 Histologic Changes of Tissue Injury
		14.6	 On the Horizon
		14.7	 Treatment of Antibody-Mediated Injury
		14.8	 Removal/Neutralization of Antibody
		14.9	 B-Cell Depletion
		14.10	 Depletion of Plasma Cells
		14.11	 Complement Inhibition
		14.12	 Summary
		References
	15: Acute Vascular Rejection
		15.1	 Terminology and Evolution
		15.2	 Pathogenesis
		15.3	 Clinical Presentation and Diagnosis
		15.4	 Treatment
		15.5	 Prognosis
		References
	16: Infectious Complications in Pediatric Renal Transplantation
		16.1	 Predisposing Factors
		16.2	 Timing of Infections After KTx
			16.2.1	 Early Post-KTx Period (the First Months After KTx)
				16.2.1.1	 Surgical Site Infections (SSIs) [5]
				16.2.1.2	 Urinary Tract Infections [7]
				16.2.1.3	 Respiratory Tract Infections
				16.2.1.4	 Clinical Sepsis
				16.2.1.5	 Viral Infections
			16.2.2	 Intermediate Time Period (1–6 Months After KTx)
				16.2.2.1	 Viral Infections
					Cytomegalovirus
					Epstein-Barr Virus [14, 15]
					BK Polyomavirus [21]
				16.2.2.2	 Fungal Infections
					Endemic Fungal Infections
			16.2.3	 Late Post-KTx Period
		16.3	 Management
			16.3.1	 Pre-transplant Evaluation
			16.3.2	 Post-KTx Immunization [25]
		References
	17: Post-Kidney Transplant Hypertension in Children
		17.1	 Introduction
		17.2	 Hypertension Epidemiology Post-Renal Transplant
		17.3	 Consequences of Hypertension in Post-Transplant Patients
		17.4	 Diagnosis of Hypertension and Importance of ABPM
		17.5	 Pathophysiology
		17.6	 Pre-Transplant Factors
		17.7	 Immediate and Early Post-Transplant Period
		17.8	 Late Post-Transplant Factors
		17.9	 Management
		17.10	 Targeted Blood Pressure in Post-Transplant Patients
		17.11	 Non-pharmacological Interventions
		17.12	 Pharmacotherapy
		17.13	 Management in the Immediate Post-Transplant Period
		17.14	 Long-Term Management
		17.15	 Summary
		References
	18: Recurrent Renal Disease After Transplantation
		18.1	 Introduction
		18.2	 Focal Segmental Glomerulosclerosis
			18.2.1	 Incidence
			18.2.2	 Risk Factors
			18.2.3	 Diagnosis and Treatment
			18.2.4	 Prognosis
		18.3	 IgA Nephropathy
			18.3.1	 Incidence
			18.3.2	 Risk Factors
			18.3.3	 Diagnosis and Treatment
			18.3.4	 Prognosis
		18.4	 Membranoproliferative Glomerulonephritis
		18.5	 Immune Complex-Mediated MPGN
			18.5.1	 Incidence
			18.5.2	 Risk Factors
			18.5.3	 Diagnosis and Treatment
			18.5.4	 Prognosis
		18.6	 Complement-Mediated MPGN (C3GN/Dense Deposit Disease)
			18.6.1	 Incidence
			18.6.2	 Risk Factors
			18.6.3	 Diagnosis and Treatment
			18.6.4	 Prognosis
		18.7	 Anti-neutrophil Cytoplasmic Antibody-Associated Vasculitis
			18.7.1	 Incidence
			18.7.2	 Risk Factors
			18.7.3	 Diagnosis and Treatment
			18.7.4	 Prognosis
		18.8	 Lupus Nephritis
			18.8.1	 Incidence
			18.8.2	 Risk Factors
			18.8.3	 Diagnosis and Treatment
			18.8.4	 Prognosis
		18.9	 Idiopathic Membranous Nephropathy
			18.9.1	 Incidence
			18.9.2	 Risk Factors
			18.9.3	 Diagnosis and Treatment
			18.9.4	 Prognosis
		18.10	 Conclusion
		References
	19: Post-Transplant Lymphoproliferative Disorders
		19.1	 Introduction
		19.2	 Pathogenesis
		19.3	 Risk Factors
		19.4	 Clinical Features
		19.5	 Pathology
		19.6	 Prevention and Preemptive Strategies
		19.7	Treatment
		19.8	Prognosis
		References
	20: How to Manage Children with Chronic Kidney Allograft Dysfunction
		20.1	 Introduction
		20.2	 Evaluation of Kidney Allograft Function
			20.2.1	 Serum Creatinine
			20.2.2	 Proteinuria
			20.2.3	 Ultrasound
			20.2.4	 Histopathology
			20.2.5	 Outcomes
		20.3	 Treatment
			20.3.1	 Immunosuppressive Therapy
			20.3.2	 Nephrectomies
		20.4	 Chronic Kidney Disease (CKD) Management
		20.5	 Conclusion
		References
Part II: Intestinal Transplant
	21: Indications for and Management of Pediatric Intestinal Transplant Patients
		21.1	 Introduction
		21.2	 Intestinal Transplantation in the Management of Intestinal Failure
		21.3	 Indications for Intestinal Transplantation
			21.3.1	 Intestinal Failure-Associated Liver Disease (IFALD)
			21.3.2	 Loss of Central Venous Access
			21.3.3	 Recurring, Life-Threatening Bloodstream, or Metastatic Infection
			21.3.4	 Intra-Abdominal Neoplastic Disease
		21.4	 Evaluation for Transplant
			21.4.1	 Confirmation of an Indication for Intestinal Transplant
			21.4.2	 Isolated Intestinal vs. Combined Liver and Intestinal Transplantation
			21.4.3	 Inclusion of Additional Organs in the Transplant
			21.4.4	 Venous Access
			21.4.5	 Assessment of Co-Morbid Disorders
		21.5	 Intestinal Transplant Allograft Types
			21.5.1	 Isolated Intestinal Transplantation
			21.5.2	 Combined Liver-Intestinal-Pancreas Transplantation
			21.5.3	 Multivisceral Transplantation
		21.6	 Management Following Intestinal Transplantation
			21.6.1	 Post-Operative Management
			21.6.2	 Enteral Nutrition
			21.6.3	 Immunosuppressive Therapy
			21.6.4	 Surveillance of the Allograft
			21.6.5	 Growth and Development After Intestinal Transplantation
			21.6.6	 Quality of Life After Intestinal Transplantation
			21.6.7	 Coordination of Care After Intestinal Transplantation
			21.6.8	 Allograft Loss and Long-Term Outcomes of Intestinal Transplantation
		21.7	 Conclusion
		References
	22: Intestinal and Multivesicular Transplantation in Children: Outcomes and Complications
		22.1	 Indications for Visceral Transplantation
		22.2	 Global Trends
		22.3	 Immunosuppressive Management
		22.4	 DSA and Liver’s Immunological Protective Effect
		22.5	 Complications
			22.5.1	 Acute Rejection
			22.5.2	 Viral Infections
			22.5.3	 Graft-Versus-Host Disease (GVHD)
			22.5.4	 Posttransplant Lymphoproliferative Disorder
		22.6	 Outcomes
			22.6.1	 Patient and Graft Survivals
			22.6.2	 Growth and Nutrition
			22.6.3	 Quality of Life
		References
	23: Long-Term Management of Intestinal Transplant Patients
		23.1	 Nutrition
		23.2	 Infections
		23.3	 Monitoring Allograft Function and Surveillance for Rejection
		23.4	 Immunosuppression and Management of Rejection
		23.5	 Renal Dysfunction and Hypertension
		23.6	 Graft vs Host Disease
		23.7	 Malignancy
		23.8	 Long-Term Development and Quality of Life
		References
Part III: Pancreatic Transplant
	24: Pediatric Pancreas Transplantation
		24.1	 Introduction
		24.2	 Incidence of Diabetes in the Young
		24.3	 Incidence of Diabetes Mellitus and End-Stage Renal Disease (ESRD) in the Young
		24.4	 Pancreas Transplantation for Pediatric Recipients
		24.5	 Reason for Pediatric Pancreas Transplantation
		24.6	 Transplantation of Pediatric Donor Organs
		24.7	 Summary
		References
	25: Total Pancreatectomy and Islet Auto-Transplantation for Chronic Pancreatitis Children: Pre-Surgical Evaluation, Patient Selection, the Surgical Procedures, Islet Isolation Procedure, and the Early Inpatient Management
		25.1	 Introduction
		25.2	 Selection of Patients for TP-IAT
		25.3	 Surgical Considerations in Pediatric Patients [21]
		25.4	 Islet Isolation and Infusion
		25.5	 Islet Cell Infusion
		25.6	 Post-Operative Care
		25.7	 Pain Management
		25.8	 Splenectomy Management
		25.9	 Surgical Morbidity and Mortality
		25.10	 Narcotic Use and Pain After TP-IAT
		25.11	 Islet Function After TP-IAT
		25.12	 Factors Predicting Insulin Independence
		25.13	 How Young Is Too Young for TP-IAT
		25.14	 Conclusions
		References
	26: Total Pancreatectomy with Islet Autotransplantation (TPIAT): Postoperative Management and Outcomes
		26.1	 Introduction to TPIAT in Children
		26.2	 Diabetes Management in the Outpatient Setting after TPIAT
		26.3	 Pain Management in the Outpatient Setting after TPIAT
		26.4	 Management of Exocrine Pancreatic Insufficiency after TPIAT
		26.5	 Nutrition Management after TPIAT
		26.6	 Other Considerations
		26.7	 Outcomes of Pediatric TPIAT
			26.7.1	 Opioid Use and Pain Relief
			26.7.2	 Insulin Independence
			26.7.3	 Quality of Life
		26.8	 Conclusions
		References
Part IV: Heart Transplant
	27: Indications and Outcomes of Heart Transplantation in Children
		27.1	 Indications of Heart Transplant in Pediatrics and in Adults with Congenital Heart Disease
		27.2	 Cardiomyopathies
		27.3	 Unrepaired Congenital Heart Disease
		27.4	 Repaired Congenital Heart Disease
		27.5	 Retransplantation
		27.6	 Changing Indications in Current Era
		27.7	 Outcomes
		27.8	 Cardiomyopathies
		27.9	 Retransplantation
		27.10	 ABO-Incompatible (ABOi) Heart Transplant Outcomes
		27.11	 Mechanical Cardiac Support and Outcomes Post-Transplant
		27.12	 Morbidity
			27.12.1 Rejection
			27.12.2 Coronary Allograft Vasculopathy (CAV)
			27.12.3 Infections
			27.12.4 Renal Dysfunction
			27.12.5 Hypertension and Hyperlipidemia
			27.12.6 Diabetes
			27.12.7 Post-Transplant Lymphoproliferative Disease (PTLD) and Other Cancers
			27.12.8 Functional Status, Exercise Capacity, and Limitations
			27.12.9 Quality of Life
		References
	28: Pediatric Heart Transplant Immunosuppression
		28.1	 Introduction
		28.2	 Peri-Transplant Immunosuppression
			28.2.1	 Induction Therapy
			28.2.2	 Polyclonal Anti-Thymocyte Globulin
			28.2.3	 Monoclonal Interleukin-2 Receptor Antagonists
			28.2.4	 Basiliximab Vs Anti-Thymocyte Globulin
			28.2.5	 Perioperative Steroids
		28.3	 Maintenance Immunosuppression
			28.3.1	 Calcineurin Inhibitors: Cyclosporine and Tacrolimus
			28.3.2	 Antiproliferative Agents: Azathioprine and Mycophenolate Mofetil
			28.3.3	 Proliferation Signal Inhibitors: Sirolimus and Everolimus
			28.3.4	 Corticosteroids
		28.4	 Side Effects of Immunosuppression
			28.4.1	 Gastrointestinal Symptoms
			28.4.2	 Myelosuppression
			28.4.3	 Diabetes Mellitus
			28.4.4	 Impaired Wound Healing
			28.4.5	 Hyperlipidemia
			28.4.6	 Chronic Kidney Disease (CKD)
			28.4.7	 Post-Transplant Lymphoproliferative Disorder (PTLD)
		28.5	 Conclusions
		References
Part V: Liver Transplant
	29: Pediatric Liver Transplantation
		29.1	 Introduction
		29.2	 Indications for Liver Transplantation in Children
			29.2.1	 Cholestatic Liver Disease
			29.2.2	 Metabolic Liver Diseases
			29.2.3	 Primary Liver Malignancy
		29.3	 Recipient Evaluation and Contraindications to Transplantation
		29.4	 Donor Assessment
		29.5	 Recipient Operation
		29.6	 Immunosuppression
		29.7	 Postoperative Surgical Complications
			29.7.1	 Primary Non-function
			29.7.2	 Biliary Complications
			29.7.3	 Vascular Complications
		29.8	 Post-Transplant Medical Complications
			29.8.1	 Acute and Chronic Rejection
			29.8.2	 Infections
		29.9	 Long-Term Outcomes
		References
	30: Perioperative Management after Liver Transplantation
		30.1	 Pre-Transplant Assessment
		30.2	 Liver Function and Associated Complications
			30.2.1 Cardiopulmonary Assessment
			30.2.2 Pre-Transplant: Admission
			30.2.3 Intraoperative Care
			30.2.4 Postoperative Care
		30.3	 Airway and Ventilation
		30.4	 Fluids and Nutrition
		30.5	 Inotropes
		30.6	 Immunosuppression
		30.7	 Renal Dysfunction
		30.8	 Radio Imaging
		30.9	 Infection Control
		30.10	 Anticoagulation
		30.11	 Immediate Post-Transplant Complications
			30.11.1 Primary Non-function (PNF) of the Liver Graft
			30.11.2 Vascular Complications
			30.11.3 Complications Due to a Large Graft
			30.11.4 Functional Small for Size Syndrome
			30.11.5 Bleeding
			30.11.6 Abdominal Drain Fluid
		30.12	 Conclusion
		References
	31: Immunosuppression after Liver Transplantation in Pediatric Population
		31.1	 Introduction
		31.2	 Background
		31.3	 Immunosuppressive Agents
			31.3.1	 Corticosteroids
			31.3.2	 Calcineurin Inhibitors
			31.3.3	 Mycophenolate Mofetil (MMF)
			31.3.4	 mTOR Inhibitors
				31.3.4.1	 Sirolimus
				31.3.4.2	 Everolimus
			31.3.5	 IL2 Receptor Blockers
		31.4	 Immunosuppression Withdrawal and Tolerance
		31.5	 Problems with Teenagers: Adherence
		31.6	 Transition to Adulthood
		31.7	 Summary
		References
	32: Combined Liver-Kidney Transplantation for Primary Hyperoxaluria Type 1
		32.1	 Introduction
		32.2	 Genetics and Pathophysiology
		32.3	 Clinical Presentation
		32.4	 Diagnosis
		32.5	 Treatment
		32.6	 Transplantation
		32.7	 Postoperative Management
		32.8	 Conclusion
		References
	33: Human Hepatocyte Transplantation
		33.1	 Introduction
		33.2	 Hepatocyte Processing and Transplantation Protocols
			33.2.1	 Source of Hepatocytes
			33.2.2	 Hepatocyte Isolation
			33.2.3	 Quality Control of Hepatocytes
			33.2.4	 Hepatocyte Infusion
			33.2.5	 Immunosuppression
		33.3	 Clinical Indications for HT
			33.3.1	 Liver-Based Metabolic Diseases (LBMD)
			33.3.2	 Acute Liver Failure (ALF)
		33.4	 Optimizing and Advancing HT
			33.4.1	 Alternative Source of Hepatocytes
			33.4.2	 In Vitro Expansion of Human Hepatocytes
			33.4.3	 Generation of Hepatocyte-like Cells from Stem Cells
			33.4.4	 Hepatocyte Co-Culture with Mesenchymal Stromal Cells
			33.4.5	 Strategies to Enhance Primary Hepatocyte Engraftment
				33.4.5.1	 Liver Preconditioning
				33.4.5.2	 Alpha-1 Antitrypsin Co-Administration
			33.4.6	 Cell Encapsulation to Evade Immune System
		33.5	 Conclusions
		References
	34: Split Liver Transplantation
		34.1	 Introduction
		34.2	 Donor Selection
			34.2.1	 Graft Allocation
			34.2.2	 Donor Criteria
		34.3	 Liver Procurement
			34.3.1	 In Situ Split
			34.3.2	 Ex Situ Split
		34.4	 Split
			34.4.1	 Before Starting
			34.4.2	 First Step: Dissection
			34.4.3	 Second Step: Hilar Vessel’s Section
			34.4.4	 Third Step: Parenchymal Transection
			34.4.5	 Final Step: Hepatic Vein
			34.4.6	 Alternative Split
		34.5	 Hepatectomy
		34.6	 Transplantation
			34.6.1	 Before Starting
			34.6.2	 First Step: Hepatic Vein Anastomosis
			34.6.3	 Second Step: Portal Vein Anastomosis
			34.6.4	 Third Step: Hepatic Artery Anastomosis
			34.6.5	 Fourth Step: Biliary Anastomosis
			34.6.6	 Final Step: Closing
		34.7	 Results
		34.8	 Complications
		References
Part VI: Lung Transplant
	35: Pediatric Lung Transplantation: Indications and Outcomes
		35.1	 Introduction
		35.2	 Transplant Evaluation
		35.3	 ECMO as Bridge to Transplant
		35.4	 Donor Acceptability Criteria and Graft Size Reduction
		35.5	 Management of Pediatric Patients Receiving a Lung Transplantation
		35.6	 Conclusion
		References
	36: Paediatric Lung Transplantation
		36.1	 Introduction
		36.2	 Indications for Lung Transplantation
		36.3	 Referrals and Candidate Selection
		36.4	 Contraindications and Exclusion Criteria
		36.5	 Donor Criteria
		36.6	 Perioperative Management and Surgery
			36.6.1 The Donor
			36.6.2 The Recipient
		36.7	 Surgical Approach
		36.8	 Early Complications
			36.8.1 Surgical Complications
			36.8.2 Primary Graft Dysfunction
			36.8.3 Hyperacute Rejection
		36.9	 Immune Suppression
		36.10	 Home Monitoring
		36.11	 Following the Transplantation
			36.11.1 Acute Rejection: Cellular and Antibody Mediated
			36.11.2 Acute Cellular Rejection (ACR)
			36.11.3 Antibody-Mediated Rejection (AMR)
			36.11.4 Infection
		36.12	 Post-Transplantation Lymphoproliferative Disorder (PTLD)
		36.13	 Chronic Lung Allograft Syndrome (CLAD)
		36.14	 Summary
		References