What is Jaundice?
Jaundice is a yellow discolouration of the skin and whites of the eyes due to abnormally high levels of bilirubin (bile pigment) in the bloodstream. Urine is usually dark because of the bilirubin excreted through the kidneys. High levels of bilirubin may be attributed to inflammation, or other abnormalities of the liver cells, or blockage of the bile ducts. Sometimes, jaundice is caused by the breakdown of a large number of red blood cells. This can happen in newborns. Jaundice is usually the first sign, and sometimes the only sign, of liver disease.
What are some common liver disease symptoms?
When diagnosing liver disease, the healthcare provider looks at the patient’s symptoms and conducts a physical exam. In addition, the healthcare provider may ask for a
Some common liver disease symptoms include the following, each of which is described briefly below:
- A yellowing of the skin and eyes
- Cholestasis (“Chole” refers to bile and “stasis” means “not moving”)
- Liver Enlargement
- Portal Hypertension (Portal Hypertension is high blood pressure in the portal vein, which supplies the liver with blood from the intestine and spleen. Portal Hypertension may be due to increased blood pressure in the portal blood vessels, or resistance to blood flow through the liver)
- Esophageal Varices (Esophageal Varices have dilated blood vessels within the walls of the lower part of the esophagus that are prone to bleeding)
- A fluid build-up in the abdominal cavity
- Hepatic Encephalopathy or Hepatic Coma (changes in the level of consciousness, due to the deterioration of brain function and damage to the nervous system. This is because of toxic substances building up in the blood, which are normally removed by the liver)
- Liver Failure
- Abnormal Bleeding
- Severe Itching
- Fatigue
What are indications or liver diseases that require Paediatric Liver Transplant?
The main indications for liver transplant in the paediatric population are as follows:
- Extra-Hepatic Cholestasis: Biliary Atresia
- Intra-Hepatic Cholestasis: Sclerosing Cholangitis; Alagille’s Syndrome; Non-Syndromic paucity of Intra-Hepatic Bile Ducts; Progressive Familial Intra-Hepatic Cholestasis
- Metabolic Diseases: Wilson’s Disease; α1-Antitrypsin Deficiency; Crigler-Najjar Syndrome; Inborn Error of Bile Acid Metabolism; Tyrosinemia; Disorders of the Urea Cycle; Organic Acidemia; Acid Lipase Defect; Oxaluria Type I; Disorders of Carbohydrate Metabolism
- Acute Liver Failure: Viral, Drug Toxicity and Poisoning
- Others: Primary Liver Tumour; Cystic Fibrosis
What are the types of Paediatric Liver Transplant?
Both deceased and living donor liver transplantation can be offered to children.
- Diseased Donor Liver Transplantation (DDLT)
In a deceased donor liver transplant the child may receive a whole liver (from a paediatric brain dead donor) or in the case of an adult brain dead donor the liver can be split into two- a bigger portion for an adult and a smaller portion for the child (Split-liver transplantation). The procedure of whole liver procurement in paediatric donors can be performed exactly as in adults. In the west, most of the transplants are from deceased donors, but in India, more than 90% of paediatric transplants are from living related donors due to lack of organ donation awareness and long waitlist time.
- Living Donor Liver Transplantation (LDLT)
Living-donor procurement involves a living related first or second-degree relative donating a portion of his/her liver to the child. The donor’s liver had 2 lobes- left and right. Depending on the size and weight of the child, the donor can donate their right lobe, left lobe or just a portion of the left lobe if the child is very small. Sometimes, the child is a newborn, and the donated liver has to be further reduced in size before transplanting the child.
In the majority of cases, living-related transplants register an excellent outcome for paediatric recipients, thanks to the possibility of performing the transplant before the child’s clinical condition deteriorates. Centres with the most experience in this area report survival rates of more than 90% after 1 year.
Living-donor selection: In living-donor transplantation, the evaluation and selection of a donor, usually a parent, sibling or a second-degree relative are performed with extreme diligence. Donors should be 18-55 years of age, and have an ABO-compatible blood type and should be suffering from any major medical or surgical illness. Following a satisfactory medical and psychological examination by physicians not directly involved with the transplantation program, a CT scan and MRI are performed to assess the anatomy. After donation, the donor’s liver grows back to almost normal size in about 4-6 weeks and they can return to normal activity in a month.
What are the child’s restrictions after Liver Transplant?
There are very few restrictions that our transplant team will recommend. We encourage shared decision making about returning to school, day-to-day activities and sports.
Many successful professional athletes and public figures have received liver transplants, such as Olympic snowboarder Chris Klug, French footballer Eric Abidal and Guitarist Phil Lesh.
Travelling is also okay as long as your child will have access to adequate health care facilities during your trip.
The best way to optimize the success of the transplant is by leading a healthy lifestyle and following the prescribed medication regimen.
Why Choose SRCC Children’s Hospital for Paediatric Liver Transplant?
Children are not smaller adults!! Liver disease symptoms, etiology (causes), and management are completely different from their adult counterparts. SRCC-NH is a dedicated children’s hospital where everyone is geared to handle the needs of small babies as well as children and adolescents. Our well-structured Liver Transplant team at SRCC-NH is an experienced team of 2 Paediatric Liver Transplant Specialists, 8 Transplant Surgeons and 10 Paediatric Transplant Intensivists.
Not just the Transplant team, the ancillary services are also provided by trained Paediatric Specialists. This ensures better management of complications which eventually leads to better outcomes. SRCC-NH is a child-friendly hospital catering to patients’ medical needs and prioritizes family-centric care.
Department of Liver Transplant at SRCC Children’s Hospital, managed by Narayana Health