What is a liver transplant for children?

A liver transplant is a surgery to replace a damaged liver with a healthy liver from a donor. The donor may be a deceased person or a living person. A living donor donates only some healthy parts of his liver. As the liver is the only organ in the body that can replace damaged tissue, the living donors liver usually grows back to normal size after the surgery.

Why does a child need a liver transplant?

A liver transplant is recommended to those children who have serious liver problems and can die without a new liver. Biliary Atresia is the most common liver disease in children. It is a rare disease of the liver and bile ducts.

Some other conditions that may require a transplant
  • Liver Cancer or Tumors.
  • Acute Liver Failure due to an autoimmune disease or an overdose of acetaminophen.
  • Genetic and Hereditary Diseases.
  • Hepatitis
  • Excessive Iron Build-up.
  • Conditions such as Alagille Syndrome.
  • An inherited condition that raises the risk of liver disease called Alpha-1 antitrypsin.

Why does a child need a liver transplant?

The possible risks of liver transplant surgery
  • Rejection of the new liver by the body’s immune system.
  • Injection.
  • Bleeding.
  • Leakage of bile or blocked bile ducts.
  • Blocked blood vessels to the new liver.
  • Rejection is the reaction of the body’s immune system to the new liver. It is a disease-fighting system to a foreign tissue or object in the body. When the new liver is placed in the child, the immune system thinks of it as a foreign object and attacks it.

    For the new liver to survive in the body, the child must take anti-rejection medicines called immunosuppressants. The immunosuppressants help in weakening the body’s immune system response.

What is the transplant evaluation process?

It is important for every child to go through a full evaluation before he or she can be placed on the transplant waiting list.

Some of the tests which need to be conducted
  • Psychological and Social Evaluation: These tests are done to check if your child is old enough to go through the transplant.
  • Blood Tests: These tests are done to find a good donor match and assess the priority of the case.
  • Diagnostic Tests: These tests are done to check the child’s liver and general health. The tests include x-rays, liver biopsy, ultrasound, and dental exams.

After all the above-mentioned tests, it will be decided if the child can have a transplant or not.

Some reasons why the child may not be able to have a transplant
  • If he has a chronic infection which cannot be treated.
  • If he has metastatic cancer.
  • If he has a severe heart problem or other health problems.
  • If he has a serious condition other than the liver disease which can’t be cured even after the transplant.
  • Blocked blood vessels to the new liver.
  • Rejection is the reaction of the body’s immune system to the new liver. It is a disease-fighting system to a foreign tissue or object in the body. When the new liver is placed in the child, the immune system thinks of it as a foreign object and attacks it.

    For the new liver to survive in the body, the child must take anti-rejection medicines called immunosuppressants. The immunosuppressants help in weakening the body’s immune system response.

How does a child get on the waiting list?

If a child is selected as a liver transplant candidate, he will be placed on the national transplant waiting list. Those who need the transplant the most are rated higher on the list. No one can determine the time it will take for a child to find a donor as it can take a few days or even weeks or years before receiving a donor organ. During this time, the child will go through a follow up with the transplant team. As soon as the donor is found, the child will have to immediately go in for surgery.

The surgery will be planned in advance if the liver is from a living donor. The donor should be in good health and have the same blood type as the child. The donor will also have to undergo a psychological test to see if he is sure about his decision.

As soon as a liver is available for your child, he will be required to go to the hospital right away. As there is no specified time for the call, it can occur anytime so one should always be ready. Once the child is at the hospital, he will have some more tests to ensure that the liver is a match. After that, the child will undergo surgery. The transplant can take many hours depending on the case. After the transplant, the patient is required to stay in the hospital for more days.

After the transplant, the child will be kept in the intensive care unit for a close watch. The duration for which the child may need to stay in the ICU will depend on the child’s condition.

Once the child is stable, he will be sent to a special unit that takes care of transplant patients. During this time, even the guardians of the child will learn about the caring of the child. This will include everything from medicines to follow up to diet to any other instructions which need to be followed.

As the child may reject the new liver, he will be required to take anti-rejection medicines to help the new liver survive in his body. The medicines, called immunosuppressants will weaken the immune system’s response. The child will have to take these medicines for the rest of his life.

As one can never really tell when exactly will rejection occur, high levels of a liver enzyme in the blood may be the first sign of rejection. Some of the signs and symptoms of rejection are:

  • Jaundice
  • Fever
  • The light color of stool
  • Headache
  • Dark urine
  • Sore or swollen belly
  • Extreme fatigue
  • Itching
  • Nausea or upset stomach

How to prevent rejection?

The child will have to take anti-rejection medicines for the rest of his life, the dosage of which may change from time to time depending on the child’s response. Blood tests will also be required from time to time to ensure that the child is getting the right amount of medicine.

As the child will be on anti-rejection medicines which affect the immune system, the child will be at a greater risk of infection. This risk is particularly high during the first few months post-surgery. During this time, the child should avoid the crowds and those with infections.

Some of the infections which are needed to be looked out
  • Oral Yeast Infection
  • Respiratory Viruses
  • Herpes
  • Epstein-Barr Virus
  • Cytomegalovirus