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    Dr. Bipin B. Vibhute ,

    1st floor Sahyadri multispecialist hospital , Karve road , erabdawane deccan gym khana, Maharashtra , 411004

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      Liver Transplant for Children : Dr. Bipin Vibhute
      • Upper Basement Sahyadri Multispeciality
        Hospital, Karve Road,Deccan Gymkhana, Pune-04
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      What is a liver transplant for children?

      • Surgery that replaced 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?

      A liver transplant is advised 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.

      Anti-rejection medications are prescribed 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?

      If your kid’s doctor believes they are a good candidate for a liver transplant, your child will be referred to a transplant centre for evaluation.

      The transplant centre’s team will meet the child and his name will be placed on a transplant waiting list by the team. 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

      It would help if the child had a full evaluation before being placed on the transplant waiting list. The transplant centre team will do many tests, including:

      1. Psychological and social evaluation: Before the child is placed on the transplant waiting list, they must undergo a thorough evaluation. Many examinations will be performed by the transplant centre personnel, including psychological and social evaluations. If the child is old enough, these tests will be performed on him or her, as well as his family.

      Blood tests. 

      Diagnostic tests: The child’s liver and overall health may be examined through tests. X-rays, 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

      People who require a new liver the most urgently are placed 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. Your child may have to wait months or years if no living related donor is discovered. Your child will be closely monitored by his or her provider and the transplant team throughout this period. During this time of waiting, there are also support groups available to assist you.

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

      The surgery will be prepared 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. The donor will also be subjected to a psychological examination. This is to ensure that he or she is happy with the decision.

      What happens during liver transplant surgery for a child?

      The parents and child will be told to visit the hospital as soon as a liver becomes available.  This call can come at any time, so be prepared to go to the hospital at any time. The child will have some final blood testing and tests at the hospital to ensure that the liver is a match.

      After that, the child will be taken 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:

      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. Your child will be placed 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.
      5. The skin over the surgical site will be cleaned with a sterile solution.
      6. 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.
      7. The doctor will carefully separate the diseased liver from the nearby organs and structures.
      8. The attached arteries and veins will be clamped to stop blood flow into the diseased liver.
      9. Different surgery methods may be used to remove the diseased liver and implant the donor liver. The method used will depend on your child’s specific case.
      10. The diseased liver will be removed after it has been cut off from the blood vessels.
      11. The surgeon will check the donor liver before implanting it in your child’s body.
      12. The donor liver will be attached to your child’s blood vessels. Blood flow to the new liver will be started. The surgeon will check for any bleeding where there are stitches.
      13. The surgeon will attach the new liver to your child’s bile ducts.
      14. The surgeon will close the incision with stitches or surgical staples.
      15. A drain may be placed in the incision site to reduce swelling.
      16. A sterile bandage or dressing will be applied.

      What happens after a liver transplant?

      Following surgery, your kid will be admitted to the intensive care unit (ICU), where he or she will be continuously monitored. The amount of time you’re the child spends in the ICU varies. It is determined by the child’s health.

      The child will be transferred to a dedicated hospital unit for liver transplant patients once he or she is stable. The child will continue to be closely monitored.

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