The Dumont-UCLA Pediatric Liver Transplant
Program offers consultation, evaluation and treatment for
children in liver failure who may require transplantation.
Program Experience
The Dumont-UCLA Pediatric Liver Transplant
Program was established conjointly with the adult program in
1984. A cohesive team approach is utilized by pediatric
gastroenterologists and liver transplant surgeons, with
consultation from a full range of pediatric sub-specialties
for post-transplant complications.
To date, over 500 pediatric transplants have
been performed, making the program the largest of its kind
in the world. Recently, the one-year survival rate has been
90 percent.
As a result of split-liver transplants,
initiated in 1996, the waiting period for transplantation
for children is often under 30 days. This time frame
compares very favorably to the national average of 197 days
for children under 1 year of age and 127 days for children 1
to 5 years old.
Program Approach
Biliary atresia is diagnosed in 50 to 75
percent of pediatric transplant recipients. Other
indications for transplantation are fulminant liver disease
and a wide range of metabolic diseases.
The evaluation for non-emergent
transplantation is usually performed on an outpatient basis.
Prior to evaluation, a telephone consultation with the
referring physician is conducted.
A pediatric gastroenterologist and a
transplant surgeon perform a full history and physical,
including a medical record review. A lengthy conference with
the family follows the evaluation.
If transplantation is imminent, a
consultation with the program's nurse coordinator and social
worker is arranged, either during the initial visit or as a
second appointment.
Laboratory testing, including a
comprehensive infectious disease screening, and an
ultrasound are ordered. A liver biopsy is also performed
occasionally.
Following evaluation and testing, transplant
candidates are reviewed by the Transplant Evaluation
Committee, made up of all team members, and a decision about
listing for transplantation is made.
Three transplantation options exist: whole
liver, split liver, or living related. The latter option is
only considered if cadaveric livers are not available.
Split-liver transplants have greatly
enhanced the utilization of donor organs. In these cases, a
whole cadaveric liver is divided into two. Approximately
one-third of the liver mass (the left lateral segment) is
transplanted into a child, and the remaining two-thirds into
an adult or large child. Once transplanted, the liver
regenerates and grows with the recipient. UCLA is one of
only six programs in the nation to offer split-liver
transplants.
Post-transplant hospital care averages three
weeks. During this time, the patient is managed by both the
pediatric gastroenterologist and the transplant surgeon.
Additionally, the Department of Pediatrics' Child Life
Program plays a major role in rehabilitation.
Research Applications
Program research consists of clinical
studies conducted in collaboration with the Division of
Liver and Pancreas Transplantation and with other pediatric
subspecialists.
The major research interest of faculty is
immunosuppression in children. UCLA pioneered the first
clinical trials for tacrolimus, a new drug option. Current
research continues to actively investigate all aspects of
tacrolimus.
Additionally, program faculty are engaged in
clinical trials of a new form of cyclosporine called neoral.
Ongoing clinical studies are being conducted
for steroid withdrawal in children, long-term renal function
and growth issues, and hepatitis C.
Team Members
Ronald W. Busuttil, M.D., Ph.D.
Professor and Chief, Division of Liver and Pancreas
Transplantation,
Director, The Dumont-UCLA Transplant Center
Sue V. McDiarmid, M.D.
Associate Professor, Division of Pediatric Gastroenterology
Director, The Dumont-UCLA Pediatric Liver Transplant Program
Marvin E. Ament, M.D.
Professor, Division of Pediatric Gastroenterology
Martin G. Martin, M.D.
Assistant Professor,
Division of Pediatric Gastroenterology
Jorge Vargas, M.D.
Professor, Division of Pediatric Gastroenterology
Douglas G. Farmer, M.D.
Assistant Professor,
Division of Liver and Pancreas Transplantation,
The Dumont-UCLA Transplant Center
Susan
Edelstein, M.D.
Assistant Professor,
Division of Liver and Pancreas Transplantation,
The Dumont-UCLA Transplant Center
Indications for Referral
Any child suspected of needing a liver
transplant may be referred to the Dumont-UCLA Pediatric
Liver Transplant Program. Early referrals are encouraged.
Contact for Patient Referral
During Business Hours:
Dumont-UCLA Pediatric Liver Transplant Program
(310) 206-6134
After-hours Emergencies:
Pediatric gastroenterologist or liver
transplant surgeon on call (310) 825-6301
Outpatient
Case Manager's Educational Supplement for the Adult 
