Liver Transplant - Paediatric
A liver transplant is a surgery that is done to replace a diseased liver with a healthy liver from a donor. Such surgery is often recommended for children who have chronic liver diseases and they cannot survive without a new liver. The most common liver disease in children is biliary atresia, where they need a new liver to live. It's a commonly found disease of the liver and bile ducts that occurs in newborns. A few decades ago, Paediatric liver transplant itself was a rare treatment procedure. However, over the last 2 decades, it has evolved as routine and standard care. Some other conditions where a child might need a liver transplant -
- Sudden or acute liver failure. It can happen due to various reasons like viral infections, the effect of an autoimmune disease, unknown causes, or an overdose of medicine.
- Metabolic liver cancer and chronic liver disease have an option to undergo liver transplant if advised, which Mazumdar Shaw Medical Centre in Bangalore, Rabindranath Tagore International Institute of Cardiac Sciences in Kolkata, SRCC Children's Hospital, Mumbai and Dharamshila Narayana Super speciality hospital in Delhi have been conducting. Narayana Institute of Liver Sciences is a comprehensive one-stop facility for treatment of all kind of gastro-intestinal tract anomalies.
Through a liver transplant surgery, a diseased liver is replaced with a healthy liver from donor (not necessarily related). Many people have had liver transplant surgeries and now lead normal lives. One of the most common reasons for liver transplant is cirrhosis caused by healthy liver cells being replaced with scarred tissues. Some other indications are: Hepatitis B, Hepatitis C, Alcohol induced cirrhosis, Auto immune Hepatitis, Liver tumors.
Risks of a Liver Transplant for a Child
Few of the risk factors from liver transplant surgery may are -
- Rejection of the new liver by the body’s immune system. It is a very common phenomenon that happens after surgery. After the new liver organ is placed in your child’s body, the immune system thinks of it as a threat and attacks it.
- Blocked blood vessels to the new liver
- Leakage of bile or blocked bile ducts
- The new liver not working for a short time right after surgery
To help your child’s immunity accept the new organ, s/he must take anti-rejection medicines called immunosuppressants. These medicines weaken the immune system’s attack on the new liver. Your child must take these medicines for the rest of his or her life. However, the doses are decreased and kept to a minimum possible dose.
The Transplant Evaluation Process.
There’s an exhaustive list of the evaluation process and procedures your child will undergo before he or she can be placed on the transplant waiting list. The transplant center team will do many tests, including:
- Blood tests – For liver transplantation, blood group matching is only required. However other blood tests are also done to find any subtle problem in other systems in both child and donor.
- Diagnostic tests - These diagnostic tests help analyse a child’s liver and general health. These tests may include dental exams, X-rays, ultrasounds, and a liver biopsy, CT scan, Echocardiography etc.
- Psychological and social evaluation - These tests are done on your child if he or she is old enough to understand what is happening and how it will change their life forever (as they will be on lifelong medication etc.)
The liver transplant team will scrutinize your child’s test results and information thoroughly and decide the fitness of the child for liver transplantation. A paediatric liver transplant team is a multidisciplinary team and usually consists of liver transplant surgeons, paediatric liver specialists (hepatologists), a transplant coordinator, paediatric intensivists, dietitians, psychologists, social workers and many other team members.
While your child waits for a transplant, keep them as healthy as possible. That way, he or she will be ready for transplant surgery when the time comes. Ensure they eat healthy foods, take all medicines and vaccines as directed, they are going for all their medical appointments. Let your doctor and the transplant center know right away in case of a deterioration of your child’s health.
In case you are wondering how long a child can live with a liver transplant, the survival rate has improved in the past decade. Most survivors achieve a normal lifestyle and a normal life expectancy.
Types of liver transplantation process:
There are two types of liver transplantation process:
- Cadaveric Liver transplantation
- Living related liver transplantation
Cadaveric Liver transplantation:
In cadaveric liver transplantation, a child gets a part of the liver or a whole liver from a deceased donor (whose family members are willing for various organ donations). Transplant team notifies you once a suitably matched donor is available. A waitlist is maintained for cadaveric liver donation.
Living Related Liver Transplant
Living family members may also donate a section of their liver in case they have a matched blood group. This type of transplant is called a living-related liver transplant. A family member who donated a portion of their liver also can live a healthy life with the remaining segment.
Benefits of Living-Donor Transplant
Such liver transplants are done from immediate families to save the child's life who needs liver transplantation and can not wait for a longer time on the waiting list. Few other benefits are:
- There's no waiting for a donor to appear from the transplant list.
- Liver transplant surgery can be planned timely and effectively.
- Donors (the family) can feel good knowing that they've had a tremendous impact on the child’s life.
- Transplant recipients may have improved long-term outcomes because they are receiving a portion of a healthy donor's liver.
Paediatric Liver Transplant FAQs
If your child has serious liver problems which are not treatable with medicines and may not survive without a new liver, then you may need to consider a liver transplant surgery. One of the most common cases which require a child liver transplant is biliary atresia. This is a condition where the liver fails to drain out the bile from the body. Some of the other conditions are:
- Sudden or acute liver failure. It can happen due to various reasons like viral infections, the effect of an autoimmune disease, unknown causes, or an overdose of medicine. liver diseases like tyrosinemia, Wilsons disease
- Genetic liver diseases like Alagille syndrome or cholestatic disorders
- Liver cancer like hepatoblastoma
- Liver tumors
- Budd chiari syndrome
- Alpha-1 antitrypsin, an inherited condition that raises the risk for liver disease
During liver transplantation, a damaged liver is removed and a healthy liver is put. So the disease is entirely treated. This surgery has a good success rate, although in some cases, surgery may have risk as explained earlier. The new liver is expected to work well if medications are taken regularly. A long, functional and healthy life is expected after liver transplantation. Children can play, go to school and enrol in professional courses when they grow. Both genders can have fruitful married life after transplantation. Near normal life expectancy is expected in children.
Before your child can get fitness for liver transplantation, he/she/they will need to go through an evaluation process. There are different tests carried out such as:
- Diagnostic tests to help check your child’s general and liver health
- Psychological and social evaluation done on your child as well as his/her/their family
- Color Doppler, CT scan, echo, chest X-ray.
These tests will help determine whether your child is eligible for a liver transplant or not. Some of the cases in which your child may not be able to have a transplant are:
- If your child has a chronic infection, active infection
- Irreversible brain damage
- If your child has heart problems (this can also be treated or operated)
- If your child has some other serious condition in other body parts that may not get better after the transplant.
Infants and new-borns can have liver transplant surgeries, however, it has a little bit more complications. Your doctor or liver transplant hospital may stabilise the disease and delay the progression of the disease to allow the baby to grow as much as possible before the transplant. If the baby is large and healthy, there are fewer chances of complications before or after the transplant. In a case, where further waiting is not possible, then liver transplantation can be done at this age also.
There are several factors that determine whether or not a potential donor is fit to donate a liver to your child or not. Some of them are:
- The age of the donor should be between 18 and 55 years
- The physical and mental health of the donor should be good
- The donor’s blood group should be compatible with that of your child