What is Pediatric Liver Transplant ?
BDS (Bachelor of Dental Surgery), 6 years of experience
What is a pediatric liver transplant?
Pediatric liver transplant is the surgery that is the last-resort for pediatric patients with end-stage liver disease and liver failure. It is an intricate surgery and requires early diagnosis. The liver is one of the largest organs in the human body which performs many essential functions like filtering toxic chemicals from the blood, metabolizing and excreting drugs, and processing other foreign substances, helps in digesting food, etc. Like in adults, liver failure can occur in children too. Many of these children recover, but some become seriously ill and may require a liver transplant to survive. In today’s article, we are going to tell you about pediatric liver transplant surgery.
- When is liver transplant needed in children?
- Which doctors are a part of the paediatric liver transplant team?
- What are the diagnostic tests done before paediatric liver transplant?
- What should be done when the child is on the waiting list for paediatric liver transplant?
- What are the types of liver donation for children?
- What happens during paediatric liver transplant?
- What are the complications of paediatric liver transplant?
- What are the sy mptoms of graft rejection?
- Success and outcome of liver transplant in children
- What is the cost of paediatric liver transplant in India?
When is liver transplant needed in children?
Liver transplant maybe needed in children due to the following reasons-
- Biliary atresia- It is the main cause of liver failure and liver transplants in children. Biliary atresia is a disease in newborns which affects the liver and bile ducts.
- Acute liver failure– This happens due to various reasons like paracetamol toxicity, autoimmune disease, drug overdose, etc. It occurs suddenly and children do not have any previous liver diseases. ( Know more about- What is Acute Liver Failure ? )
- Chronic liver failure – It occurs when a long-lasting liver disease becomes worse, either gradually or suddenly. The only treatment option for chronic liver failure is a liver transplant.
- Wilson’s disease– This is a genetic disease where excess copper deposits in the child’s body. ( Know more about- What is Wilson’s Disease? )
- Alagille syndrome– This is a condition in children where bile builds up in the liver.
- Alpha-1 antitrypsin deficiency– This is a genetic disease that can cause symptoms like severe difficulty in breathing and jaundice in children.
- Tyrosinemia- This is a metabolic disease where the body is unable to break down amino acid tyrosine which leads to various liver and kidney disturbances.
- Viral hepatitis – This is a viral infection that causes liver inflammation. Symptoms may include- flu-like symptoms, fever, jaundice, etc. ( Know more about- What is Hepatitis B ? )
- Hemochromatosis– Iron overload in body
- Lipid storage disorders- For e.g. Gaucher disease, Niemann-Pick disease, cholesterol ester storage disease
- Carbohydrate storage disorders– For e.g. galactosemia, glycogen storage diseases
- Hepatoblastoma– Liver cancer in children. ( Know more about- What is Liver Cancer? )
- Cystic fibrosis- This is a genetic disease damaging digestive system organs like liver and other organs like lungs.
- Other Genetic or Hereditary liver disorders
Which doctors are a part of the pediatric liver transplant team?
Liver transplant requires a transplant team that includes –
- hepatobiliary surgeons
- liver specialists (hepatologists)
- transplant coordinator
- dietitians
- psychologists
- social workers
What are the diagnostic tests done before paediatric liver transplant?
The entire liver transplant team does a wide range of tests to check if the child is ready for surgery physically, mentally, financially, etc.
The variety of tests performed to assess the child are-
- Imaging tests-chest X-rays, ultrasound, CT scans, MRI Scans
- ECG. ( Know more about- What is Echocardiography? )
- Pulmonary function tests
- Biopsy (in case of liver cancer)
- Blood tests- for checking liver and kidney functions
- Psychological assessment
Once the child passes all the above tests and the initial evaluation is done for liver transplant, the next step is to find a liver donor. If the child cannot get a donor from the family, he is put on the waiting list for the donor liver of a deceased person. The child may have to wait for a good match.
What should be done when the child is on the waiting list for paediatric liver transplant?
Keeping the child healthy when he/she is on the waiting list is very crucial. A few things can be done to ensure that the child is kept at optimum health.
- eat healthy foods
- take all medicines as directed
- follow all medical appointments
- tell your doctor right away if there is any change in your child’s health.
You need to be in close contact with your transplant team so that they can inform you immediately when a donor is available. It is advised to keep a bag ready to move as once the donor is available, the child needs to be quickly moved and taken into surgery.
What are the types of liver donation for children?
Liver donation in children is done in two ways-
- Deceased Liver Donation – After testing and evaluation, if no donor is found in the patient’s family, then the patient is kept on the waiting list for a deceased liver donor. Some consent forms need to be filled in for this process. The waiting period depends on the availability of a good match. Most brain dead donors can be adult women or men. The liver requirement in children does not depend on body weight. The procedure can be done in 20 to 30 percent of the liver. When the donor is found, the donor’s liver is split into two parts. The liver comprises 60 to 70 percent of its right side. The larger part goes to an adult patient, and the smaller part goes to a child. Although, if the brain dead donor is a child, the entire liver will go to a child. The liver regenerates itself to its full size inside its new host.
- Living Liver Donation – In children, an entire liver is not required as only a small portion of the liver is enough for them. In general, the left part of the liver (which is almost 20 to 30 percent of the liver) is sufficient for transplant. Living donors can include family members, such as parents, uncles, grandfathers, aunts, grandmothers. But the donor’s blood group and type should match with the child’s blood group. The liver transplant should be done within 12 hours of removing a portion from the donor’s liver. The portions of the liver in both the donor and the patient regenerate by 90 to 100 percent within 6 to 8 weeks.
What happens during a paediatric liver transplant?
Paediatric liver transplant surgery may take 4 to 12 hours depending on the condition of the child’s liver. During the surgery, the child’s old liver and gallbladder will be removed. Since gallbladder is no longer needed, a new one is not transplanted. The new liver is then transplanted.
Depending on the type of liver donation, the liver transplants can be classified as:
- Whole-liver transplant
- Split adult cadaveric organ grafting
- Living-donor transplant
After surgery, your child will be shifted directly to the intensive care unit (ICU), usually for one to two days. Immediately after surgery, a breathing tube will be inserted to help him or her breathe. In most of the cases the tube can be removed within 24 hours after surgery. Multiple monitoring lines are attached that are removed as your child becomes more stable. When your child is ready to leave the ICU, he or she will be shifted to the recovery rooms.
What are the complications of pediatric liver transplant?
- Bleeding
- Hepatic artery thrombosis
- Hepatic artery stenosis
- Infection
- High blood pressure ( Know more about- What is Hypertension? )
- Gastric problems
- Graft (new liver) rejection- this is the most dreaded complication
What are the symptoms of graft (new liver) rejection?
The risk of graft (new liver) rejection is maximum in the first few months so a close eye should be kept on the patient to see for any of the following signs-
- Fever
- Trouble breathing
- Vomiting
- Weight gain
- Weight loss
- Poor appetite
- Yellowish skin or eyes (jaundice)
- Dark urine
- Light-colored stools
- Itching
- Swollen or sore belly
- Extreme tiredness or fatigue
- Feeling grouchy or irritable
- Headache
- Upset stomach or nausea
Contact your doctor immediately in case of any of the signs of graft rejection and other complications after surgery.
Success and outcome of liver transplant in children
Children usually lead their normal lives after a liver transplant. A few months after the surgery, children start going to their school comfortably. Apart from this, children start playing at least six months after surgery. According to experts, the success rate of liver transplant surgery in children is 90 to 95 percent after the completion of 1 year and more than 85 percent after the completion of 10 years.
What is the cost of pediatric liver transplants in India?
The total cost of pediatric liver transplant in India can be estimated between INR 17,00,000 to INR 24,00,000. Many top hospitals and skilled doctors in India perform paediatric liver transplant.
For a patient coming to India from abroad, there will be some additional charges that include- Hotel Stay, Local Travel, etc in addition to the expenses of paediatric liver transplant. After the surgery, the patient is advised to stay in the hospital for a few days, following which the patient is recommended to stay in any local hotel/ housing facility for several days for better recovery, before he/she plans to go back. The total cost of paediatric liver transplant in India comes to INR 26,00,000 to INR 30,00,000 .
We hope that we could answer your questions regarding Paediatric Liver Transplantation Surgery through this article.
If you need more information about Paediatric Liver Transplantation you must contact a Paediatric Liver Transplant Surgeon.
We only aim to give you information through the article. We do not recommend medication or treatment in any way. Only a doctor can give you the best advice and correct treatment plan.
