This epidemiologic disparity between donor size and recipient needs led to the use of reduction hepatectomies/segment liver transplantation and the development of other innovative transplant surgical techniques based on reduced size grafts, including split liver transplantation and the

use of organs from living donors.[96-99] These advances allowed more widespread application of liver transplantation for children. During 2011-2012, 64 centers performed at least one liver transplant in a patient <18 years of age; 23 programs performed 20 or more transplants in this population during that time frame.[100] Pediatric pretransplant Staurosporine concentration mortality has steadily decreased, most dramatically for candidates less than 1 year of age. The number of new pediatric candidates added to the liver transplant waiting

list was 704 in 2011.[100, 101] In 2011, there were 477 deceased donor pediatric liver transplants and 59 living donor transplants. Graft survival has continued to improve for pediatric recipients. Despite this high success rate, challenges remain, including the need for targeted preoperative management to address the problems of malnutrition, and improved methods to prevent graft loss while avoiding the consequences of immunosuppression, such as posttransplant lymphoproliferative disease (PTLD) and renal injury.[99] All elements were in place for expansion and validation of Pediatric Hepatology. In the mid-1990s centers that focused this website on Pediatric Hepatology became a component of many divisions of Pediatric click here Gastroenterology. Research flourished with the application of state-of-the-art cellular and molecular biology techniques and the emergence of molecular genetics, which enhanced our understanding and recognition of the pathophysiological and genetic basis of an increasing number of disorders of the liver

in children.[102] With clinical and research efforts converging, the field rapidly gained momentum. The next key ingredient to establishing the formal field was to create and sustain a critical mass and validate the concept of Pediatric Hepatology as an academic subspecialty. In a decision that reflected validation and maturity, “Hepatology” was added to the name of the major Pediatric Gastroenterology society—which became the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN). This is symmetrical with the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). In 1993, perhaps as a measure of the growth of the field (or the verbosity of the author) the chapter on Liver Disease in Infancy and Childhood in the 7th Edition of Diseases of the Liver (Leon and Eugene Schiff; editors) was 104 pages long!103 A community of colleagues interested in Pediatric Hepatology was being built.