Purpose: A paediatric liver transplant is recommended in the following cases:

• Chronic (long-term) liver failure
• End-stage liver disease
• Cirrhosis of the liver (a chronic liver disease in which healthy liver tissue is replaced with scar tissue)
• Acute hepatic necrosis (when the liver dies due to a reaction to drugs, medicines, or toxins)
• Biliary atresia (a rare disease in which the bile ducts, which are tubes carrying bile from the liver to the intestines, are obstructed)
• Viral hepatitis (a viral infection caused due to Hepatitis B or C)
• Autoimmune hepatitis (inflammation of the liver due to the body’s immune system or disease-fighting system attacking the liver)
• Alagille syndrome (a genetic disorder that may cause the bile ducts to fail or narrow)
• Primary sclerosing cholangitis (a condition in which the bile ducts narrow due to scarring and inflammation)
• Hepatoblastoma (a rare cancerous tumor that spreads to the other parts of the body)
• Metabolic diseases (disorders that can change the chemical activity in the cells that are affected by the liver)
• Certain genetic disorders, like:
• Alpha-1 antitrypsin deficiency (a hereditary disorder that leads to liver failure and hepatitis)
• Wilson disease (a hereditary disorder in which there is copper accumulation in the liver and nervous system, leading to severe liver disease)
• Tyrosinemia (a genetic disorder associated with severe liver disease in infants)

Symptoms: The following symptoms may indicate the need for a liver transplant:

• Nausea
• Diarrhea
• Fever
• Vomiting 
• Loss of appetite
• Fatigue
• Jaundice
• Easy bruising
• Swelling in the legs and feet
• Abdominal pain
• Ascites (fluid in the abdomen)
• Sleepiness
• Pale stools 
• Dark urine
• Mental confusion 

1. Physical examination: Your overall physical health will be evaluated by the doctor. The symptoms, medical history, and family history of the patient are noted.
2. Blood tests: These tests help to determine how well the liver of the child is functioning and to assess the function of the kidney.
3. Chest x-ray: It helps to detect infection in the lungs and assess the status of the bones of the child in the chest area.
4. Electrocardiogram (ECG): This test helps in detecting any changes in the child’s heart rhythm.
5. Pulmonary function tests: These tests help in measuring the lung capacity of the child. The child is asked to breathe into a machine, and blood is drawn to determine how well oxygen is being absorbed from the lungs.
6. Ultrasound: It helps to view the flow of blood to and from the liver of the child, and to detect any abnormal masses that may be present in the liver.
7. Computed tomography (CT) scan: It is an imaging test that helps in obtaining a clear image of the liver size and shape, its blood supply, and the presence of any liver lesions.
8. Liver biopsy: If a liver tumor is suspected, the doctor may excise a small sample of the same and send it to the laboratory for evaluation.

• The procedure is performed under general anesthesia, which means that the child will be put to sleep during the procedure.
• The skin over the site of surgery is cleaned with a sterile solution.
• The doctor makes a cut or incision just under the ribs on both the sides of the child’s belly.
• The incision extends up over the breast bone.
• The doctor carefully separates the diseased liver from the nearby structures and organs.
• The attached arteries and veins are clamped to stop the flow of blood into the diseased liver.
• Different surgical methods could be used to remove the diseased liver and implant the donor liver in its place, depending on the specific case of the child.
• The diseased liver is removed after being cut off from the blood vessels.
• The surgeon checks the donor's liver and then implants it into the child’s body by attaching it to the blood vessels of the child.
• The blood flow to the new liver is started.
• The new liver is attached to the bile ducts of the child.
• The incision is closed using sutures (stitches) or surgical staples.
• A drain may be placed near the incision site to reduce the swelling.
• A dressing or sterile bandage is applied over the incision site.
• The procedure may take 10 to 12 hours to complete.

The following complications are associated with a paediatric liver transplant:

• Bleeding
• Infection
• Blood clot formation
• Allergic reaction to the anesthesia used
• Rejection of the transplanted liver by the body’s immune or disease-fighting system
• Complications from anti-rejection medications, like cancer
• Blocked blood vessels to the newly transplanted liver 
• Leakage of bile
• Blocked bile ducts
• Transplanted liver not working for a short period after surgery
• Recurrence of liver disease
• Death

1. The child is kept in the pediatric intensive care unit (PICU) after the procedure.
2. The child will be shifted to a normal hospital room in a few days.
3. The child will stay in the hospital for two to three weeks after the surgery.
4. Once the child goes home, several follow-up appointments with the doctor are needed to ensure that the transplanted liver is working well.
5. Initially, the follow-up visits are scheduled every week. The frequency of follow-ups decreases with time. Eventually, lab tests are recommended every two to three months to check if the new liver is functioning well.
6. Anti-rejection medications, also known as immunosuppressants are prescribed. These medications help in preventing the rejection of the transplanted liver by the body’s immune or disease-fighting system and need to be taken lifelong.
7. The immunosuppressants may make the child more susceptible to infections, especially in the first few days after the surgery. It is advisable to keep the child away from sick people and wash the child’s and caretaker’s hands frequently to prevent infection.
8. Most children having a liver transplant go on to live a healthy, normal life.
9. The child is encouraged to exercise regularly, eat well, and get plenty of rest to keep the new liver healthy.

Watch for symptoms of infection or rejection in your child and contact the doctor immediately if you notice any of the following transplant:

• Fever
• Tiredness
• Vomiting
• Coughing
• Weight loss
• Loss of appetite
• Diarrhea
• Stomach pains
• Jaundice