Liver Transplantation for Children
Your child needs a full evaluation before he/she can be placed on the transplant waiting list. The team will do many tests, including:
- Blood tests. Includes complete blood counts, liver function test, kidney function test, blood group, viral markers etc.
- Diagnostic tests. Tests are done to check the child’s liver and general health. These tests may include X-rays, ultrasounds, 2D echocardiography, if required liver biopsy.
Types of liver transplant:
Living-donor liver transplants
Many transplant centers throughout the world have improved the technique of living-donor liver transplantation. Current data implies that the results of living-donor liver transplant are at least similar to, and possibly better than, cadaveric donor liver transplantation.
The basis for taking a part of a living person’s liver lies in the organ’s individual capacity to grow back (regenerate) to its normal size. A part of the liver (a lobe) can be removed without causing any damage in liver function.
Deceased-donor liver transplants
In most cases, a healthy liver will come from an organ donor who is brain dead. Either a whole liver or a part of liver may be transplanted.
While a liver transplant is the only treatment for many patients with end stage liver disease, there are not enough cadaveric donor livers to meet the needs of all possible recipients. Split-liver transplants involve sharing a cadaveric donor’s liver so that two recipients (one small child and one adolescent or adult) may benefit from one liver donation.
What is paediatric liver transplant?
A liver transplant is surgery to replace a diseased liver with a healthy liver from another person.
The new liver may come from an organ donor who is brain dead or part of a liver may come from a healthy living person. This is called a living donor. A living donor should be a family member.
The liver is the only organ in the body that can replace (regenerate) lost or damaged tissue.
The donor’s liver will soon grow back to normal size after surgery. The part that your child receives as a new liver will also grow to normal size in a few weeks.
Why might my child need a liver transplant?
A liver transplant is suggested when your child’s liver doesn’t work well and they cannot survive without liver transplant. Biliary atresia is the most common liver disease in children for which liver transplantation is required. This is an unusual disease of the liver and bile ducts that occurs in newborns.
Other conditions may include:
- Liver cancer and other liver tumors
- Acute liver failure due to an autoimmune disorder, unknown causes, or an excess of medicine, such as acetaminophen
- Other hereditary liver disorders
- Conditions present at birth, such as Alagille syndrome or cholestatic diseases
- Viral hepatitis
- A development of too much iron in the body, which can damage organs. This is called hemochromatosis.
- Alpha-1 antitrypsin, an inherited disease that increases the risk for liver disease
How do I get my child ready for a liver transplant?
If your child’s pediatrician thinks he/she may be a good applicant for liver transplantation, they will refer your child to a transplantation center for evaluation.
Your child will meet the transplantation team. Depending upon child’s liver condition, transplant team will decide for cadaveric liver transplant listing or living donor liver transplant. The transplantation team includes:
- Transplant surgeon
- Hepatologist
- Transplant anesthetist
- Pediatric transplant intensivist
- Transplantation nurses
- A social worker
- A psychiatrist or psychologist
- Dietician
What happens during liver transplant surgery for a child?
In cadaveric donor liver transplantation, once a liver is available for your child, you and your child will be advised to go to the hospital quickly. This can happen at any time, so you should be ready to go to the hospital at any time. At the hospital, your child will have some blood work and tests to check his/ her current status and also to rule out infection.
Your child will then go into operation. The transplant may take few hours. This will differ depending on your child’s case.
After liver transplant surgery your child will be in ICU for few days then will be shifted into room. After transplant hospital stay will be 2 to 3 weeks. It depends on your child’s pre-transplant status and post-transplant recovery.