Pediatric Liver Transplants
Pediatric liver transplant is surgery that is performed to remove a diseased liver in order to replace it with a healthy one. It is very successful in treating children with liver diseases that cannot be treated with routine medications and surgeries and offering them an opportunity to live a long and healthy life.
Who is a candidate for a Liver Transplant?
Children who suffer from end-stage liver disease due to various causes and when the likelihood of surviving without transplant is less than surviving with transplant, the child may be considered for liver transplantation. The most common indication in children is biliary atresia. Biliary atresia is a rare condition in newborn infants in which the common bile duct between the liver and the small intestine is blocked or absent. Bile ducts, which are tubes that carry bile out of the liver, are missing or damaged in this disease, and obstructed bile causes cirrhosis. Bile helps digest food. If unrecognized, the condition leads to liver failure.
The cause of the condition is unknown. The only effective treatments are certain surgeries, or liver transplantation. Other causes of liver transplant can be autoimmune hepatitis (chronic liver damage due to attack of body’s own immune system), viral hepatitis (chronic viral infection causing inflammation of the liver), primary sclerosing cholangitis (chronic condition in which tubes connecting the liver become narrowed, blocked, and scarred), and tumors of the liver.
How is it decided that my child needs a Liver Transplant?
Eligibility is determined by a comprehensive medical evaluation by the transplant team.
Pre-transplant evaluation process:
This consists of checking all the body systems with regards to optimal function and presence of unexpected disease. Your child’s immunization records will be reviewed. Following transplantation, some vaccines cannot be given and others may not be as effective.
A detailed nutritional assessment will also be performed. Several tests will be performed:
- Laboratory blood and urine tests
- Electrocardiogram (ECG)
- Chest X-ray
- CT scan of the liver and blood vessels
How long will the surgery take?
A typical liver transplant can last from 8-12 hours. The surgery for the donor lasts approximately 5-6 hours. During the operation, surgeons will remove the child’s liver and will replace it with the donor liver. The surgeon will disconnect the diseased liver from the bile ducts and blood vessels before removing it.
The blood that flows into the liver will be blocked or sent through a machine to return to the rest of the body. The surgeon will put the healthy liver in place and reconnect it to the bile ducts and blood vessels. Your child’s blood will then flow into your new liver. Because a transplant operation is a major procedure, surgeons will need to place several tubes in the body. These tubes are necessary to help the body carry out certain functions during the operation and for a few days afterward.
What are the risks of transplant surgery?
There are risks with transplant surgery just as with any major surgery. Some immediate complications can include bleeding and blood clotting problems, respiratory problems and malfunction of the donor liver. Long-term complications include rejection (when the child’s immune system does not accept the new liver) and infection. Fortunately, most of these complications are treatable.
What is the postoperative period like for the child who undergoes Liver Transplantation?
After your child’s surgery, he/she will be taken to transplant ICU where he/she will stay for a week. After your child is transferred out of ICU to the pediatric floor, the length of stay will depend on how quickly he/she recovers. Average length of hospital stay is about 3 weeks.
What medications will my child take at home after Transplant?
Your child will take 2 major types of medications in addition to multivitamins and health supplements to prevent rejection. If your child misses a dose, you need to contact our team. immediately.
Once my child leaves the hospital, what happens?
Initially your child has to come to the transplant clinic twice a week for laboratory work up and physical examination or as frequently advised by our team. As recovery progresses, these visits become less frequent.
Who will look after my child long-term?
Your child will be looked after by the primary pediatrician who will be supported by our team.
What restrictions will my child have during her recovery?
For the first six weeks after surgery, your child should avoid strenuous exercises.
When can my child return to school?
Your child should go back to school about 12 weeks’ post-discharge. You have to meet ahead with the teacher to discuss your child’s medical needs such as medication schedule, follow-up doctor appointments, and possible effects of the medication taken by your child like weight gain, facial changes etc.
What lifestyle changes are associated with Liver Transplants?
Most patients can return to a normal or near-normal lifestyle six months after a successful liver transplant. Recipients should avoid exposure to people with infections. Maintaining a balanced diet, and staying on prescribed medications are vital to stay healthy. Children can attend school and participate in sports and other age-appropriate activities and can have a normal married life in the future with no fertility issues.
What is the survival rate for children with Liver Transplants?
Survival rate depends on several factors like age and health condition of the child. However, our results are comparable to the most well established centers from across the world.
Apollo Hospitals Center for Pediatric Liver Transplants
Apollo Hospitals, Navi Mumbai have a Comprehensive Liver Transplant Program to provide the care and support the child and the family needs. We have performed over 50 Pediatric Liver Transplants including transplant in a youngest 4-months-old child. These transplants have been successfully performed out at subsidized costs with a more than 90% success rate that compares with the best in the world.
Members of Liver Transplant Team:
These physicians take care of child before the transplant, after the transplant (in coordination with the transplant surgeon), and also after discharge from the hospital.
These physicians perform your child’s Pediatric liver transplant operation and oversee your child’s care in the hospital following the surgery
These doctors administer anesthesia medicine to your child and monitor him or her during the transplant surgery.
This person arranges your child’s care before and after transplant, helps answer your questions, and provides support for you and your family.
Many children with liver disease are not able to maintain normal weight. Hence, a nutritionist would be monitoring the child’s diet and growth before and after the transplant.
Medical Social Worker
Medical social worker helps patients and families with the pretransplant waiting time, the hospital stay, discharge and care after your child returns home.
Along the way, you will also meet many other people who will provide care for your child and your family, including critical care physicians, general pediatric nurses, and physical and occupational therapists. Overall, these individuals will help you and your family get through this stressful time
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