Recurrence of disease after liver transplantation in the pediatric population

Disease relapse after liver transplantation occurs infrequently in the pediatric population, and the spectrum of recurrent conditions differs from that which is seen in adults. Chemotherapy followed by liver transplantation as primary treatment for hepatic malignancies such as hepatoblastoma and hepatocellular carcinoma yields excellent outcomes with low recurrence rates, even in the presence of locally advanced tumors. End-stage liver disease secondary to hepatitis C viral infections is an uncommon indication for liver transplantation in pediatric patients, but the rates of recurrent viremia and retransplantation appear similar to adult recipients with hepatitis C. The posttransplant management of children with disorders of immune regulation (such as autoimmune hepatitis) is particularly challenging, as they often require a greater degree of immunosuppression and yet are at elevated risk for disease relapse. The return of cholestasis has also been reported for liver transplant recipients with specific types of biliary diseases, such as primary sclerosing cholangitis, progressive familial intrahepatic cholestasis subtype 2, or sclerosing cholangitis associated with the multisystem disorder Langerhans cell histiocytosis.