Paediatric Liver Transplant

A paediatric liver transplant refers to a surgical procedure where a damaged liver is replaced with a healthy liver in children (less than 18 years of age). A liver transplant is the definitive treatment for children with end-stage liver disease, also known as cirrhosis of the liver. The procedure is complex and requires a team of specialised medical professionals. Children who undergo liver transplants require lifelong monitoring and medication to prevent rejection of the new liver.

Why is a liver transplant required for a child?

A liver transplant may be required for children who suffer from liver disease that cannot be treated with medication or other therapies. Some common liver diseases that may require a liver transplant in children include biliary atresia liver cancer. Biliary atresia is a rare disease that causes blockage of the bile ducts, leading to liver damage.

Children can also have a host of genetics like Wilson's Disease. Maple syrup wine disease, Tyrosinemia, for which a liver transplant is required. Acute liver failure is a condition where a child needs an emergency transplant.

Transplant Evaluation Process:

Before a liver transplant, a thorough evaluation is done to determine whether the child is a suitable candidate for the procedure. The evaluation includes medical history, physical examination, blood tests, and imaging studies of the liver. The child's overall health, age, and weight are also considered.

Once the evaluation is complete, a multidisciplinary team, including surgeons, paediatric haematologists, and radiologists, evaluates the child in tandem. Since living donor liver transplantation is the most common form of transplant in India (other being deceased donors),

Preparations for Transplant:

• Medical evaluation: The child will undergo a comprehensive medical evaluation to determine the severity of their liver disease.
• Psychological evaluation: The child and their family will undergo a psychological evaluation to assess their ability to cope with the transplant process and its aftermath.
• Pre-transplant testing: The child will undergo a series of tests to evaluate their heart, lungs, kidneys, and other organs to ensure they are healthy enough for surgery.
• Lifestyle changes: The child and their family may need to make lifestyle changes, such as a special diet or exercise regimen, to improve their overall health before the transplant.
• Education and support: The child and their family will receive education and support from a team of healthcare professionals, including a transplant coordinator, social worker, and nutritionist. They will also be connected with a support group for families of children who have undergone liver transplants.

While the surgery can be life-saving, it is not without risks and potential complications. Here are some of the most common risks and complications associated with paediatric liver transplant:

Procedure for Transplant:

The following steps are taken for a successful paediatric liver transplant.

• Evaluation and selection of a suitable donor liver: The donor liver must be a good match for the child's blood type, body size, and medical condition.
• Surgery to remove the diseased liver: The child will undergo surgery to remove the damaged liver.
• Implantation of the donor's liver: The healthy liver will be implanted into the child's abdomen and connected to the blood vessels and bile ducts.
• Monitoring and recovery: The child will be closely monitored for complications, such as rejection or infection, and will need to take immunosuppressant medications for the rest of their life.

Risks and Complications after Surgery:

• Infection: After surgery, the child may be at risk of developing an infection at the surgical site or in other parts of the body.
• Bleeding: Bleeding is a common risk during surgery and may also occur in the days or weeks following the procedure, which may need a relooking surgery.
• Rejection: The child's body may reject the transplanted liver, which can cause complications and may require additional treatment.
• Bile duct complications: Problems with the bile ducts can occur after surgery, leading to a build-up of bile and potential infection.
• Recurrence of the original liver disease: In some cases, the child's original liver disease may return, even after a successful transplant.

Recovery after Surgery:

The recovery process after a paediatric liver transplant can be lengthy and challenging, but it is an essential part of the child's journey back to health. Here are some important things to keep in mind:

• The child will need to stay in the hospital for several weeks following the surgery.
• They will likely experience some pain and discomfort during the recovery process.
• Medications to prevent rejection will need to be taken for the rest of the child's life.
• With time, the child should be able to resume normal activities, although they may need to take precautions to protect their new liver.

How Parents Can Support Children with Liver Transplant:

Here are some ways that parents can support their child through the process:

• Stay positive and offer emotional support throughout the recovery process.
• Help the child adhere to their medication schedule and attend follow-up appointments.
• Encourage the child to stay active and engage in activities that they enjoy.
• Ensure that the child maintains a healthy diet and avoids substances that could harm their liver.
• Reach out to support groups and other resources for additional assistance and guidance.

Why Choose Max Hospital for Surgery?

Here are some reasons why parents may choose Max Hospital for their child's liver transplant:

• The hospital has a high success rate for liver transplant surgeries.
• The Centre of Liver and Biliary Sciences has one of the largest paediatric liver transplant programmes in the country.
• The healthcare team is dedicated to providing personalised care and support throughout the process.
• The hospital has state-of-the-art facilities and equipment to support transplant surgery and recovery.
• The hospital is located in a convenient and accessible location.
• The hospital has a strong track record of providing exceptional care to paediatric patients.

Frequently Asked Question

How long can a child live with a liver transplant?
A liver transplant can significantly increase the lifespan of a child suffering from end-stage liver disease or acute liver failure. The lifespan after a liver transplant depends on several factors, such as the child's overall health, the age of the child at the time of transplant, and the reason for the liver transplant.

Can a child get a liver transplant from an adult?
Yes, a child can receive a liver transplant from an adult. In fact, adult-to-child liver transplantation is the most common type of liver transplantation performed in children. However, the size of the donated liver is an important consideration in such cases. The size of the liver must be appropriate for the size of the recipient, and this size match is especially important in children. To ensure the best possible outcome, the liver transplant surgeon must carefully match the size of the donor's liver with the size of the child's liver. ABO-incompatible liver transplants are also routinely done in children in our centre.

Can a family member donate a portion of the liver?
Yes, a family member can donate a portion of their liver to a child or adult who requires a liver transplant. The donated liver piece can regenerate and eventually grow to a functional size in both the donor and recipient. This type of transplant is called a living donor liver transplant. Living donor liver transplants have several advantages over deceased donor transplants, including a shorter wait time, improved outcomes, and a lower risk of complications such as organ rejection. However, it's essential to note that living donor liver transplants are major surgical procedures that carry risks, and the decision to donate should be made after careful consideration and medical evaluation.

What disqualifies you from a liver transplant?
Several factors may disqualify a person from receiving a liver transplant, including severe medical conditions such as active cancer, severe heart or lung disease, or an active infection. Each transplant centre may have its own guidelines for assessing a person's eligibility for a liver transplant, and the decision to proceed with a transplant is based on a careful evaluation of the person's overall health and likelihood of success.

How much does a liver transplant cost for babies?
The cost of a liver transplant for babies can vary greatly depending on several factors. The average cost of a liver transplant includes pre-transplantation, surgery, and post-transplantation costs. However, the cost for infants can be much lower due to the need for specialised equipment and facilities, longer hospital stays, and intensive care. Additionally, the cost can vary based on the location of the transplant centre, insurance coverage, and the need for additional procedures or treatments. It is essential to check with the transplant centre and insurance provider to understand the total cost of the transplant and available financial assistance options.

How long does a live liver transplant take?
The duration of a live liver transplant can vary depending on several factors, including the complexity of the surgery, the experience of the transplant team, and the overall health of the donor and recipient. Generally, a live liver transplant can take anywhere from 6 to 18 hours to complete. Both patient surgeries proceed simultaneously. After the transplant, both the donor and recipient are closely monitored for complications and recovery progress. The length of hospitalisation after a liver transplant can also vary, ranging from several days to several weeks, depending on the patient's condition and recovery progress. It is essential to consult with the transplant team to understand the estimated time frame and potential risks associated with live liver transplant surgery.

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