Liver Transplant
A Pediatric Liver Transplant is a surgery/ operation done to replace a child diseased or malfunctioning liver with a healthy one. The new liver could come from a deceased organ donor or from one of the family members who is willing to donate a part of their liver, provided he/ she is a suitable candidate (i.e. the blood type needs to match). People who donate part of their liver can live healthy lives with the liver that is left as the liver is the only organ in the body that can replace or regenerate lost or damaged tissue. The donor’s liver will soon grow back to normal size after surgery, and so will the part of the liver the child has received.
In most cases livers come from deceased organ donors – those adults or children who are critically ill or injured and doctors have declared them brain dead.
Doctors recommend a liver transplant for those children who have serious liver issues and will die if they receive a new liver.
The possible complications that may arise from a liver transplant for a child may include the following:
In any transplant, rejection to a foreign object or tissue is a normal reaction of the body’s immune system. When a new liver is placed in the body, the immune system might think it to be a thread and starts attacking it or rejecting it.
To address this issue, doctors or hepatologists (specialists who diagnose and treat diseases of the gallbladder, pancreas and liver) prescribe anti-rejection medicines that are called immunosuppressants. Immunosuppressants are medicines that weaken the response of the body’s immune system and the child would need to take these medicines for the rest of his/ her life.
There are several steps in the process of getting a liver transplant:
This is the first step and the objective is to find out whether the child is a possible candidate for a transplant. Doctors consider liver transplants as a last option when all other treatment options have been ruled out. Further, not everyone can get a liver transplant and this could be because of the following reasons:
And if the doctor thinks a liver transplant is right for the child, he/ she will refer you to a transplant center.
On visiting a transplant centre, the doctors would provide information about the following:
At the transplant centre, the team of health professionals will include all or some of the following personnel: transplant coordinator, transplant surgeons, hepatologist, financial & insurance coordinator, social worker, psychiatrist and a dietitian.
The child getting a liver transplant would need to go through a series of evaluations and might need to visit the transplant center several times. The team will enquire about your medical history and also get some medical tests, such as, a physical exam, blood & urine tests, imaging tests, heart, lungs & kidney function tests etc.
The results of these tests give the team vital information about the patient which would help them decide if the child is healthy enough to undergo the surgery or not. Further, the team might recommend not going forward with the surgery under the following conditions:
The transplant team will also figure out whether the child and his/ her caregivers are able to understand the doctor’s detailed instructions for care post-transplant. The team also needs to be sure whether the child and his/ her caregivers are mentally prepared for the caring needed for a new liver.
The results of the evaluation will be reviewed by a selection committee that is put in place by the transplant centre. The government has put in place certain guidelines about who can get a liver transplant. The committee reviews the test results basis these national guidelines and also basis the transplant centre’s own guidelines.
If your child is approved for a liver transplant and you do not have a living donor, the transplant centre will submit your name to be placed on the National Waiting List for a liver from a deceased donor. And in case, you have a living donor then the transplant centre does not place you on the national waiting list.
Once your child’s name is placed on the National Waiting List, the waiting period can can be from less than 30 days to even more than five years. However, the waiting period does depend on how badly a new liver is needed. Also, factors, such as age, blood type, body size, overall health and the availability of a matching liver could contribute to making the waiting period longer or shorter.
When a matching liver from a deceased donor is found, the transplant team will inform you and brief you on what needs to be done.
If a family member, or a relative or a family friend, is to be a donor, the transplant team will need to determine whether the child and the donor have blood types that work together and will ask for the donor’s medical history and perform certain medical tests to make sure that the donor is in good general health.
NOTE: The potential donor must be between the ages of 18 and 60 and should be able to understand and follow instructions both before and after surgery.
Once the availability of a liver is confirmed, your child and you would be asked to come to the hospital immediately. At the hospital, your child will need to undergo a blood test and some other tests to confirm that the liver is a match.
Your child will then be taken to the OT for the transplant and that can take several hours depending on the child’s case. During the surgery, the transplant team keeps you informed about how the surgery is going. Do note that a liver transplant surgery requires the child to stay in the hospital.
Typically, a liver transplant follows the following process:
Post-surgery, your child will be taken to an ICU to be watched closely. After your child is stable, he/ she will be taken to a special unit that care for liver transplant patients. You will now receive a detailed briefing about how to take care of your child and this briefing will include information about medicines, activity, follow-up schedule, diet and other instructions that you should know.
Rejection of the new liver is a normal reaction of the body’s immune system because when a new liver is placed in your child’s body, the immune system mistakes it to be a threat and attacks it.
The hepatologist prescribes some anti-rejection medicines to help the new liver survive in your child’s body. These medicines are known as immunosuppressants and they weaken the response of the immune system. Do note that your child would need to take these medicines for the rest of his/ her life.
Since anti-rejection medicines weaken the immune system, your child will be at a greater risk for infections. The risk is very high in the first few months after surgery and your child should avoid crowds. Your child will need to take medicines that prevent infections from occurring.
It is not always easy to tell when rejection occurs, however, high enzyme levels in the blood may be the first side of rejection.
While symptoms vary, the common symptoms of rejection may include the following:
Do note that the above symptoms may seem like symptoms of other health problems. Your child’s transplant team will cover what to do if any of these symptoms occur, during the briefing.
Living with a serious condition can be really hard for children and surgery and taking immunosuppressant medicine only adds to the woes. You, as a mother, should talk to your child and explain about the changes and how they can be worked into the daily routine.
You, as a mother should make sure that you are always there whenever your child wants to talk. And if you require more support, you should speak to your transplant team because the psychologist on the team can be of great help. Moreover, you should get support for yourself too – talk about your feelings with other people who know and understand what you’re going through.