Pediatric liver transplant is a surgical procedure, and the standard mode of treatment performed on children suffering from a variety of liver diseases which lead to acute liver failure, or those with a progressive end-stage liver disease. During the procedure, the unhealthy liver is replaced with a healthier liver from a healthy donor with the same blood type.

The most common liver disease in children that requires a liver transplant is biliary atresia. Biliary atresia is a condition that affects the bile ducts, and only occurs in infants, whereby the said ducts get inflamed and blocked shortly after birth. The condition restricts the movement of bile from the liver to the gall bladder. As a result, this leads to build-up of bile, which damages the liver and affects other vital body functions.

Other conditions that may require a liver transplant in children include:

• Autoimmune disease as a result of acute or sudden liver failure
• Liver cancer and tumours
• Congenital disorders
• Viral hepatitis
• Hemochromatosis, which is the build-up of too much iron in the blood
• Genetic or inherited disorders
• Gall bladder disease
• Hepatoblastoma liver tumour, which is an abnormal tissue growth starts in cells that are in the right lobe of the liver
• Metabolic diseases such as Crigler-Najjar syndrome
• Obstructive cholestasis (extrahepatic cholestasis) which is a blockage that occurs outside the excretory part of the liver and bile ducts

Pediatric Liver Transplant Evaluation Process

During the evaluation stage for a liver transplant, your child will undergo through a series of examinations, which include blood tests and other diagnostic tests to assess the level of liver damage. The child will also be evaluated to see if he or she is fit and does not have any other underlying health conditions, chronic infections or metastatic cancer. These conditions may prevent the child from being put on the waiting list as they may worsen with time.

Techniques Involved in Pediatric Liver Transplant Surgery

There are different techniques used in pediatric liver transplant.  These include:

Whole Liver Transplant

A whole liver transplant is done in four stages whereby the donor hepatectomy liver is extracted with its blood supply from a deceased healthy individual and is preserved by core cooling, recipient hepatectomy whereby the entire infected liver is removed, implantation of the four vascular anastomoses (grafting), and finally the haemostasis and bile duct rehabilitation.

Split Cadaveric Liver Transplant

This is a procedure where both the right and left lobes of the liver are transplanted in two different recipients. The whole liver from a healthy donor is divided in two sections turning it into two partial organs. The left lateral segment would be transplanted to a child, and the right segment which is extensive is transplanted to an adult.

Living-donor Liver Transplant

During the procedure, the liver is extracted from a healthy living donor most likely the mother and is then transplanted to the child who has the affected liver.

Reduced Size Liver Transplant

In this procedure the whole liver is extracted from a dead healthy and matching donor. It is then reduced in size and grafted to the recipient.

Risks Involved in Pediatric Liver Transplant

Just like any other surgical procedure, a pediatric liver transplant comes also with risks, but these can be managed in a timely manner.

After the transplant surgery, the immune system may reject the new liver initially, but this is normal as foreign bodies such as tissues or object tend to be rejected. This is because the immune system feels like it is being attacked. If this occurs, anti-rejection medications are usually given. To prevent rejection, your child often goes through a series of blood tests in order to avoid other symptoms such as jaundice, itching and irritation, fatigue, swelling of the stomach and headaches.

Infection is also prone to occur in the first few months after the transplant due to the anti-rejection medicine. Therefore, the child is kept in isolation from crowds or polluted areas to avoid the said infections.

Post-operation

After the liver transplant surgery, the child will stay under observation in the intensive care unit, and this stay is dependent on the rate of recovery of the child. Thereafter after the child becomes stable, he or she will be transferred to a highly dependent unit that specifically cares for liver transplant patients. The parent will also be educated on the care for the child, medications, diet and the doctors’ follow-up schedule after discharge.

Next Step

At King’s College Hospital; our pediatric liver specialists are UK board certified and come with decades of experience. While here, we will ensure that your child receives the best possible care. Contact us to find out more about our pediatric hepatology services or to arrange an appointment.

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