Children, just like adults, are susceptible to organ failure that requires organ transplantation as treatment. The common organs that can be transplanted in children are kidneys and liver.
Liver Transplantation in Children
Liver failure in children occurs in two forms:
- Acute – it occurs suddenly and over a period of a few weeks
- Chronic – the liver damage occurs over several months and years
The common causes for acute failure are infections such as viral hepatitis, and side effects of drugs such as paracetamol. The commonest cause of chronic failure is Biliary Atresia where there is a malformation of the small ducts that drain bile from the liver. Other causes include genetic and metabolic diseases such as Wilson’s disease (where there is abnormal deposition of copper within the body). However, liver failure from Biliary Atresia is the commonest indication for liver transplantation in children, accounting for about 50% of all liver transplants carried out.
Liver Transplantation, although a very complex procedure, has an excellent success rate in these very sick children – immediate survival and long-term being about 95% and 85% respectively.
Though cadaveric donation is preferable, children are also uniquely suited for living donor transplantation. In fact, a majority of liver transplants carried out in NH are from living donors with usually one of the parents donating a portion of their liver to their child. The donors to do well and the donation has no impact on their long-term health and lifestyle.
Kidney Transplantation in Children
Common causes of kidney failure in children are related to congenital malformations in the kidneys and urinary system. Other causes include infections, drug-induced kidney injury, etc. Unlike liver failure where transplantation is the only option, children with kidney failure can be stabilized with dialysis. However, dialysis is associated with significant risks and even death over a medium term.
Therefore, even in this situation, kidney transplantation provides a much superior outcome and an excellent quality of life for the child. Again, while the cadaveric organ is preferred, there is a severe shortage and live donor, usually from one of the parents, becomes the best option for the child.
Life after Solid Organ Transplantation in Children
Children after a successful organ transplantation, lead near-normal lives. Their growth and development improve and they catch up with their peers. They can pursue all age appropriate activities including schooling, sports, and other physical activities.
However, children will continue to remain on immune-suppression medication. This is required to allow the child’s body to accept the transplanted organ and prevent rejection. Long-term immune suppression also has its own problems, therefore, it is mandatory for these children to be under continuous medical supervision.
Pediatric Solid Organ Transplant Program at NH
NH has been a pioneer in promoting and setting up pediatric solid organ transplantation in the country. A special team of child-centered physicians, surgeons, nursing and technical staff ensure that even the smallest of babies and others with high risk are carried through to successful transplants.
We have transplanted children from all parts of India and also from several countries abroad. Several charities and organizations have collaborated with NH to fund transplantation in children in need of these procedures.
The writer, Dr. Sanjay Rao, is a senior consultant pediatric organ transplant surgeon at Mazumdar Shaw Medical Center, Narayana Health City