Liver Transplant For Children

What is a liver transplant for children?

• Surgery that replaces diseased liver with a healthy liver.
• There are two types of donors
  • Living organ donor (family member or a person found a match)
  • or from a dead donor
• The liver is the only organ in the body that can regenerate itself to its normal size in a few weeks.

Why might my child need a liver transplant?

Doctors will advise liver transplant for children with severe liver disease, who will die if they do not receive a new liver. Biliary atresia is the most frequent liver condition in children who need transplants. It is a rare liver and bile duct disorder that affects new-borns.

Other conditions may include:

Cancer of the liver and various malignancies of the liver

• An autoimmune disease, unknown reasons, or an overdose of drugs, such as acetaminophen, can induce sudden or acute liver failure.
• Other congenital and genetic liver diseases.
• Alagille syndrome or cholestatic diseases, for example, are conditions that are present at birth.
• Viral hepatitis
• Overabundance of iron in the body, which can harm organs. Hemochromatosis is the medical term for this condition.
• Alpha-1 antitrypsin deficiency is a hereditary disorder that increases the risk of liver disease.

What are the risks of a liver transplant for a child?

The following are some of the possible side effects of a liver transplant:

• The immune system of the body rejects the new liver.
• Bleedings Infection
• The new liver’s blood arteries are blocked.
• Bile leakage or clogged bile ducts

Rejection is the immune system’s (or disease-fighting system’s) natural response to a foreign substance or tissue. When the child’s body receives a new liver, the immune system perceives it as a threat and assaults it.

Doctors will prescribe anti-rejection medications to the child for the new liver to survive in their body. Immunosuppressant’s are medications that weaken the immune systems. These medicines must be taken by your child for the rest of his or her life.

What should I do to prepare my child for a liver transplant?

Pediatric liver transplant surgeon will refer your child to transplant centre for evaluation if your child is good candidate for liver transplant.

The transplant centre’s team will meet the child and they will put child’s name on a transplant waiting list. The following people will be part of the transplant centre’s team:

• A surgeon who specialises in transplants
• A hepatologist is a transplant specialist who specialises in liver treatment.
• Nurses who work with transplant recipients
• A social worker is a person who helps people.
• A psychiatrist or psychologist can help you.
• Dietitians & anesthesiologists are among the other members of the team.

The transplant evaluation process

The tranplant personnel will perform a full evaluation on the child before putting him/her on the transplant waiting list. The transplant centre team will do many tests, including:

Psychological and social evaluation: Before the transplant team puts child on the transplant waiting list, they must undergo a thorough evaluation. The transplant centre personnel will be perform many examinations, including psychological and social evaluations. They will also perform these tests on parents and child if she/he is old enough

Blood tests

Team of expert doctors will run diagnostic tests and examine overall health of child’s liver. X-rays, blood tests, ultrasounds, a liver biopsy, and dental checkups are examples of these testing.

The transplant center team will look at all of your child’s test results and information. Each transplant center has rules about who can have a liver transplant.

Your child may not be able to have a transplant if he or she:

• Has a current or chronic infection that can’t be treated
• Has metastatic cancer. This is cancer that has spread from its main location to one or more other parts of the body.
• Has severe heart problems or other health problems
• Has a serious condition besides liver disease that would not get better after a transplant

Getting on the waiting list

The transplant system puts people who require a new liver the most urgently at the head of the list. Your child may only be on the waiting list for a donated organ for a few days or weeks. If transplant team will fails to discover living donor then he/she has to wait months or years. Transplant team will closely monitor child’s provider throughout this period. During this time of waiting, there are also support groups available to assist you.

Because a donor has died, doctors  will inform when a liver becomes available. You must immediately go to the hospital so that your child can prepare for surgery.

The transplant team will prepare in advance if the liver comes from a living donor. The donor and the child will both have surgery at the same time. The donor must be in good physical condition. He or she must have a blood type that is similar to that of the child. Doctors or counsellors in hospital will do psychological examination of donor. This is to ensure that he or she is happy with the decision.

What happens during liver transplant surgery for a child?

The transplant doctor or some one from the transplant team will call the parents and child to visit the hospital as soon as a liver becomes available. Hospital can call at any time, so parents has to prepare themselves to reach hospital on time. The child will have some final blood testing and tests at the hospital to ensure that the liver is a match.

Transplant team will take the child to surgery. It’s possible that the transplant will take many hours. This will depend on your child’s situation. During the procedure, a member of the transplant team will update you on the progress.

Generally, a liver transplant follows this process:

 

Pre-Surgery Preparations and Anesthesia Administration

1. An IV or intravenous line will be started in your child’s arm or hand. Other tubes or catheters will be put in the neck and wrist. Or they may be put under your child’s collarbone or in the groin area. These are used to check your child’s heart and blood pressure, and to get blood samples.
2. Doctors will place the child on his or her back on the operating table.
3. A catheter will be put into your child’s bladder to drain urine.
4. Your child will be given general anesthesia so that he or she is in a deep sleep. After your child is sedated, the anesthesiologist will put a tube into your child’s lungs. This is so that your child’s breathing can be helped with a machine called a ventilator. The anesthesiologist will keep checking your child’s heart rate, blood pressure, breathing, and blood oxygen level during the surgery.

Surgical Procedure and Post-Surgery Steps

1. Transplant team will clean the skin over the surgical site with a sterile solution.
2. The doctor will make a cut or incision just under the ribs on both sides of your child’s belly. The incision will extend straight up for a short distance over the breast bone.
3. The doctor will carefully separate the diseased liver from the nearby organs and structures.
4. The doctors will attach arteries and clamp veins to stop blood flow into the diseased liver.
5. The surgeons will use different surgery methods to remove the diseased liver and implant the donor liver. The method used will depend on your child’s specific case.
6. The team will remove the diseased liver after cutting it off from the blood vessels.
7. The surgeon will check the donor liver before implanting it in your child’s body.
8. Doctors will attach donor’s liver to your child’s blood vessels. Blood flow will start to the new liver. The surgeon will check for any bleeding where there are stitches.
9. The liver surgeon will attach the new liver to your child’s bile ducts.
10. The doctor will close the incision with stitches or surgical staples.
11. Surgeons will place a drain in the incision site to reduce swelling.
12. Doctor will apply a sterile bandage or dressing on the surgical part.

What happens after a liver transplant?

After surgery the ICU staff will monitor your chlid closely. The amount of time you’re the child spends in the ICU varies. Child’s health will determine how much time she/he will spend in ICU.

Transplant staff and doctors will transfer the child to a dedicated hospital unit for liver transplant patients once he or she is stable. Doctors and staff will monior your chlid closely.