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Shiraz University of Medical Sciences Pediatric Liver Transplantation Name: Age: Wt. (Percentile): Sex: Blood group: Pt. No.: Age at putting on waiting list: Liver histopathology: Kasai Operation Age at time of Kasai: Complications on waiting: Encephalopathy Pruritus GI bleeding Hepatorenal Sx. Ascites SBP Hepatopulmonary Sx. Infections Others ………… Child score: PELD score: Date of liver transplantation: Age at time of Tx. Graft type: Graft Wt: Donor relation: Donor age: Donor Wt.: Donor blood group: Surgery Technique: Post Tx. Complications: Hepatic artery thrombosis Portal vein thrombosis Hepatic vein thrombosis Rejection Infections BM Suppresion Renal problems Ascites Cardiopulmonary problems Biliary complications Convulsions Bowel Perforation Reoperation: Cause: Duration of admission in ICU: Duration of admission in Ward: Late complications: Vascular thrombosis Biliary obstruction Infections Drug side effects PTLD Site:……………. Rituximab Biopsy:…………. Explanted liver histopathology: Death Date: Cause: Rejection Chemotherapy