Liver transplant in children: What is it?
The liver transplant procedure involves removing the diseased liver from a patient and replacing it with a healthy liver.
New livers can be obtained from deceased and healthy donors. However, transplants can also come from healthy living individuals. These are called living donors. Living donors may be related to your child, although they do not have to be relatives of your child.
It is the only organ in the body that can regenerate (replace) lost or damaged tissue, so those who donate their livers can continue to live healthy lives.
The liver transplant donor will grow up to its previous size soon after surgery. The liver transplant recipient will also grow in size after a few weeks.
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What are the reasons a child might need a liver transplant?
Children who cannot recover from liver disease and die without receiving a new liver are more likely to need a liver transplant. The most common liver disease that requires a liver transplant occurs in newborns born without liver tissues.
The following conditions may also occur:
- Various types of liver tumors including liver cancer
- Debilitating liver disease is a result of an autoimmune disease, an overdose of medication, or another type of medication.
- There are also hereditary and genetic liver diseases.
- Conditions like Alagille syndrome and cholestatic disorders might be present at birth
- Viral hepatitis
- An excess of iron in the body, causing organ damage. This is known as hemochromatosis.
- It increases liver disease risk as a result of inherited antibodies to alpha-1 antitrypsin.
Do liver transplants for children come with risks?
Liver transplant surgery can lead to the following complications:
- The immune system of the body rejects the new liver.
- The new liver has blocked blood vessels.
- Bloated biliary ducts or leaking bile
- Shortly after surgery, the surgeons noticed that the new liver was not working.
In children with a liver transplant, their immune system attacks it when a new liver is placed into their body, believing it to be a threat. Rejection is a natural reaction of the body’s immune system to a foreign object.
Immunosuppressive drugs weaken the immune system’s response so the liver can survive inside your child. Your child must take immunosuppressives for the rest of his or her life to ensure that they receive the new system’s functions.
My child needs a liver transplant. How do I prepare him?
A liver transplant center located in a certain hospital throughout the United States provides liver transplants to patients who have a provider who thinks that they are special candidates for liver transplants.
During the meeting, your child will meet with the transplant team. The team will decide whether your child should be listed on the national transplant waiting list. At the team meeting, your child will meet with experts from the following transplant centers:
- Transplant surgeons
- A hepatologist is a specialist in treating liver diseases.
- Nurses specializing in transplantation
- Social workers
- Psychiatrists or psychologists
- Other team members, including dietitians, chaplains, and anesthesiologists
Transplant evaluation process
To be placed on the transplant waiting list, your child must undergo a thorough evaluation by a transplant center team that includes:
- Social and psychological evaluation. If your child is old enough, these tests will be performed on them and your family.
- Blood tests. Testing like this would improve the chances that the donor’s liver won’t be rejected by your body, which is crucial for finding a good match.
- Diagnostic tests. The doctors may schedule X-rays, ultrasounds, liver biopsies, and dental exams to check your child’s liver and overall health.
Every liver transplant center has rules about who is eligible for a transplant. The medical team will examine the child’s test results and information.
The following conditions might prevent your child from receiving a transplant:
- Have an untreatable, chronic infection.
- Your child may have metastatic cancer, which occurs when cancer has spread from one site in the body to other places.
- Health problems such as severe heart conditions
- A serious complication in addition to liver disease that would prevent transplantation from working.
Being added to the waiting list
Once your child is approved for a transplant, they will go on a waiting list for organs. People with the most urgent need for transplants are placed on the list first. Your child may only spend a few days or even weeks on the waiting list before receiving a liver. It can take up to a year to find a living-related donor for your child, and the child will be required to have regular follow-ups with his or her provider. Support groups are open to assist you and your child during this process.
If a liver becomes available due to a deceased donor, you will be contacted. Your child must meet with the doctor immediately to receive the medication needed to get ready for surgery.
Your child will undergo surgery at the same time with a donor who has good health and has blood types that match his or her own blood type. The donor will undergo a psychological examination to ensure that he or she is comfortable with the process.
During liver transplant surgery for a child, what will happen?
Your child will be instructed to go to the hospital immediately after donation. This call may come at any time, so be ready to go to the hospital. At the hospital, final blood tests will be performed to ensure that the liver provided is an appropriate match.
A transplant team member will let you know how the surgery is going while your child is undergoing surgery. The surgery may take 6 to 12 hours depending on your child’s case.
You may need to stay in the hospital for a few days following liver transplant surgery. The specific procedure can vary depending on your child’s condition and the doctor’s practices.
Liver transplants generally take the following route:
- A gown will be given to your child to wear after they remove their clothing.
- Your child’s arm will be connected to an IV line. Other tubes will be placed in the neck and wrist, or under the collarbone or around the waist. These will allow your child to have their heart rate and blood pressure monitoring, and blood samples collected.
- An operating table will be used for your child.
- The bladder will be drained using a catheter.
- Anesthesia will be administered to your child so that they can breathe with the aid of a breathing apparatus called a ventilator. Please be assured that they will be closely monitored during the procedure by the anesthesiologist.
- A sterile solution will be used to clean the skin over the surgical site.
- An incision will be made between your child’s ribs, shortly above the breast bone, and will extend straight up over the belly.
- The doctor must separate the diseased liver from nearby structures and organs.
- The diseased liver will be stopped from receiving blood from the affected arteries and veins by clamping them off.
- The method used is determined by your child’s individual case and will depend on the specific procedure.
- A biopsy will be performed to assist in deciding whether the liver is diseased and whether it should be removed.
- During surgery, the surgeon will use a donor liver, which will be disinfected before implantation.
- During the procedure, your child’s blood vessels will be attached to the donor’s liver, and blood will flow to the new liver. The surgeon will check for any bleeding at the site of the stitches.
- Your child’s liver will be attached to bile ducts by the surgeon.
- An incision is closed by surgical staples or stitches.
- It may be necessary to place a drain in the incision site to help reduce swelling.
- Bandages or dressings will be applied sterilely.
If a child receives a liver transplant, what happens next?
In the intensive care unit (ICU) following your child’s surgery, the length of time your child stays will depend on their condition. The ICU will be monitored closely for a period of time.
After the liver transplant, your child will be stabilized and go to a hospital ward where only liver transplant patients will be housed. You will receive all the information you need regarding hospitalization care, including medicines, supplements, follow-ups, diet, and any other instructions they may provide.
When your child’s new liver is placed in his body, the immune system may try to reject it. Rejection is the body’s protective system replying to a foreign object, tissue, or organ.
Your child must take anti-rejection medicines that weaken the immune system for the rest of his or her life to help the removal liver survive. These medicines are called immunosuppressants.
The immune response can be controlled best by anti-rejection medicines in the weeks immediately following the procedure; however, rejection can still occur just as often in other circumstances.
There is no easy way to determine whether a patient is rejecting their transplant. A blood test that shows elevated liver enzyme level could be the first sign.
As your child ages, it is important to know the symptoms and signs of rejection. Some signs and symptoms may include those listed below.
- Dark urine
- Yellowish skin or eyes (jaundice)
- Light-colored stools
- Swollen or sore belly
- Extreme tiredness or fatigue
- Feeling grouchy or irritable
- Upset stomach or vomiting
When your child’s transplant team indicates that they need to call right away in case of rejection, the symptoms may look similar to other health issues. They will let you know who to call.
During your child’s lifetime, they will have to take anti-rejection medicines, and they may need different doses based on their response to these medicines. Each child will probably react differently to medicines, and every transplant team will choose medicines differently based on their own experience.
A doctor needs to take regular blood tests on your child to measure the amount of medicine he or she is receiving. White blood cells are another sign of how much medicine a child needs to be taking.
Children with liver transplants are at increased risk for infections because anti-rejection medicines affect the immune system. This is especially true in the first few months after surgery since antibiotics are given at higher doses at that time.
Your child should stay away from crowds and anyone who has an infection for a few months following the surgery.
The following infections are more likely to occur if your child takes antibiotics:
- Respiratory viruses
- Thrush or oral yeast infection
- Epstein-Barr virus
Living with a liver transplant
It is difficult to live with a liver transplant. Your child will have to take anti-rejection medicines for life so that the new liver will not be attacked by the immune system. Infections are one of the side effects of anti-rejection medicines. Additional medicines must be given to prevent them. You and your child need to keep working closely with the transplant team.
The best thing that they can do is to learn all about anti-rejection medicines when they are older. They should also learn all the signs of rejection, and everything else you have learned. This will help them learn to practice self-care independently one day.