Jana Kosnáčová, Jarmila Hornová, Vladimír Bzdúch
Introduction: The work assesses the current state of childcare from Slovakia before and after liver transplantation. The authors review the indications to liver transplantation of paediatric patients, the possibilities of transplantation, current immunosup- pressive therapy. The authors evaluate the most common chronic liver disease leading to transplantation in children. Patients and methods: Patients before and after liver transplantation have made an objective examination, with assessment of overall condition, additional laboratory tests (haematological, biochemical, immunological, virological, microbiological, mycological examinations), X-ray, liver biopsy and histological examination, imaging tests of liver. In assumption that the do- nor was a parent, the parent also had passed the basic examination. Ultimately, decision of the suitability for child from living related donor is on surgeon. Results: Currently in the medical care of doctors of the 1st Paediatric Department of Children´s University Hospital are 11 children (8 boys and 3 girls) aged from 10 months to 13 years after liver transplantation. All children underwent transplan- tation at the transplantation centres abroad (10 x Essen, Kiel 1 x). The most frequent diagnosis leading to liver transplantation in our youngest patients was biliary atresia - 8 cases. In other cases, children were indicated for liver transplantation for cystic liver disease (1 x), acute hepatic failure (1 x) and hepatoblastoma (1 x). In two cases, patients have received cadaverous organs. In one case, first graft was given to the child from a living related donor, but for the acute complication there was an acute need for retransplantation from a cadaverous donor. In eight cases living related donors = parents were donors of grafts (twice a fa- ther and 6 times a mother), in one case a liver transplant graft was from AB0 incompatible mother. After liver transplantation, these children are treated in the 1st Paediatric Department of Children´s University Hospital according to the Protocol of a foreign transplantation centre. Patients are set to immunosuppressive therapy, which must be taken life-long. Even in paediat- ric patients complications have appeared, the occurrence of which is comparable to the incidence of complications in adults. Discussion and conclusion: We currently provide care for children before and after liver transplantation. Quality of care is comparable with care in transplantation centres abroad. Liver transplantation for Slovak children is carried out mainly abroad trans8 children received grafts from living relatives. Parents who have been donors of grafts have no serious complications. The disadvantage of liver transplantations abroad is the high price. Slovakia currently lacks an experienced and knowledgeable surgical and anaesthetic team that can perform transplantations in paediatric patients. Thanks to excellent cooperation with the transplant team in Essen Slovak children survive with diagnoses that without liver transplantation would not have chance to survive.