Pediatric liver transplantation in Uzbekistan: first clinical case and outcome analysis

Background . Liver transplantation (LT) remains the only life-saving option for children with end-stage liver disease. In Uzbekistan, a national LT program was launched in 2018; however, pediatric LT had not been performed until recently. Objective : to report the fi rst documented case of related pediatric LT in the Republic of Uzbekistan and to highlight key aspects of postoperative management, including rejection crises, recurrent autoimmune hepatitis (AIH), and the innovative use of bortezomib for treating steroid-resistant rejection. Materials and methods . A 15-year-old patient with liver cirrhosis secondary to AIH was selected for transplantation. The right hepatic lobe from a living donor was transplanted following comprehensive preoperative evaluation and preparation. The procedure involved surgical intervention followed by a multistage postoperative treatment protocol. Results . The transplant procedure was successful. However, in the early postoperative period, the patient developed a rejection crisis that proved resistant to standard therapy with glucocorticosteroids and antithymocyte globulin. Subsequent evaluation revealed a recurrent AIH. Bortezomib was administered as part of the therapeutic strategy, leading to normalization of laboratory parameters and restoration of graft function. Conclusion. This fi rst case of pediatric LT in Uzbekistan demonstrates the feasibility of performing complex surgical interventions and managing challenging postoperative complications. The use of bortezomib for steroid-resistant rejection associated with AIH highlights a potentially promising therapeutic approach. These results mark an important step forward in the development of transplant care in the country.