Pediatric Liver Transplant

What is Pediatric Liver Transplant?

A pediatric liver transplant is a surgery in which the child’s sick liver is removed and replaced by a healthy liver from a donor. The transplant process is carried out when the doctors have tried every other treatment option and the child won’t survive without a transplant.

The liver donor can be an adult or a child who has pledged organ donation (or their family has agreed) after their death, called a Deceased Liver Donor.

Children and adults also receive a transplant from a Living Liver Donor. In this case, the donor is a willing living person who undergoes an operation in which either the left or right lobe of the liver is removed. The right lobe is bigger in size, hence better suited for adults whereas the left lobe is recommended for children. The donor can be your family member or a close friend who has a compatible blood type and approximately matches your liver size. After surgery, the donor’s liver will rapidly get back to its normal size. In the case of children, the donated liver grows as the child grows.

Pediatric Liver Transplant

Why might a child need Liver Transplant?

Children with severe liver issues who wouldn’t survive without a new liver are advised to get a liver transplant. Biliary atresia is the most typical liver condition in children who require transplants. This is a rare liver and bile duct condition that occurs in newborns.

Other conditions may include:

  • Other liver tumors and liver cancer
  • Conditions like Alagille syndrome or cholestatic disorders that are present at birth
  • Acute or sudden liver failure brought on by an autoimmune condition, unidentified factors, or a medication overdose, such as acetaminophen
  • Viral Hepatitis
  • Other inherited and genetic liver conditions
  • Hemochromatosis or the accumulation of too much iron in the body lead to organ damage
  • A hereditary disorder known as alpha-1 antitrypsin increases the risk of liver disease
  • Tyrosinemia is a genetic condition associated with liver disease in infants
  • Wilson disease is a hereditary condition where copper builds up in the nervous system and liver, leading to organ damage

Risks of Liver Transplant for a child

The liver disease that led to a transplant may have affected other organ systems and their functioning too. Other probable complications from the surgery may include

  • Hemorrhage: The liver produces clotting factors (chemicals that help blood clot). Its capacity to make clotting factors is compromised when the liver fails. The child will get blood products both before and after surgery to address this issue. But, if the liver fails to start working quickly right after the surgery, significant bleeding does occur during the first 48 hours of the transplant, and the kid may need to undergo additional surgery to stop the bleeding. We anticipate that the new liver will begin functioning quickly to help prevent any excessive bleeding.
  • Thrombosis: The new liver could be harmed if a blood clot develops in a vein going to or from it. To avoid this, the child is given specific anticoagulant medicine.
  • Rejection: The work of our body’s immune system is to protect it from invading organisms. Unfortunately, the immune system doesn’t identify the replacement liver and doesn’t understand its work, the body rejects it. The immune system, therefore, tries to attack the new liver. The child needs to take anti-rejection medications called Immunosuppressants in order for the new liver to survive inside the body. The immune system’s response is weakened by these medications. They have to take these for the rest of their life. Though usually the amount taken is reduced as the body gets familiar with the new liver.

Transplant Evaluation

The child will have to undergo various tests and evaluations as part of the transplant evaluation process before they are placed on the National waiting list.

The Transplant team will conduct tests including:

  • Psychological and Social Evaluation– these tests are conducted on the child (to understand and know as much as possible about the child) and make the family understand everything better.
  • Blood Tests– These tests are carried out to determine your child’s priority on the waiting list and to assist in finding a good donor match. They may also reduce the likelihood of donor liver rejection.
  • Diagnostic tests– Tests are performed to check the child’s liver and health in general. These may include X-rays, ultrasounds, a liver biopsy, and dental exams.

After the evaluation process, the child will be added to a national transplant waiting list if they are approved as a transplant candidate. The top of the list is reserved for those who most urgently require a new liver. Your child may get a donor within a few days or weeks.

Living with a Liver Transplant

Living with a Pediatric Liver transplant is a process of an entire lifetime for the child. He/she would have to be on anti-rejection medicines so that the body’s immune system doesn’t attack the new liver. Other medicines must also be taken to avoid any side effects (such as infections) from anti-rejection medicines.

Apart from this, the child carries on a normal lifestyle example school, sports, activities, etc.

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