Liver Transplant

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KEY POINTS

• A liver transplant is surgery to replace a damaged or diseased liver with a healthy donor liver. The donor is usually a person who has recently died. Less often, a living relative may donate part of their liver to your child.
• If a liver transplant is your child’s best option, your child’s name will be placed on a list of people waiting for a donor liver. When a matching donor liver is found, you will be notified and told to take your child to the transplant center quickly.
• After transplant surgery, your child will need to take medicine to keep the body from rejecting the liver. Your child will take these medicines for the rest of his or her life.
• Ask your provider how to take care of your child at home. Make sure you know what symptoms or problems you should watch for and what to do if your child has them.

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What is a liver transplant?

A liver transplant is surgery to replace a damaged or diseased liver with a healthy donor liver. The donor is usually a person who has recently died. Less often, a living relative may donate part of their liver to your child.

When is it used?

The most common reason for a liver transplant in a child is biliary atresia. Biliary atresia is a rare, life-threatening condition that can affect babies soon after birth. It means that there is a blockage in the small tubes going from the liver to the small intestine. Blockage of the ducts can damage the liver.

How do I prepare my child for this procedure?

Your healthcare provider will refer your child to an evaluation team at a hospital where this kind of surgery is done. The team includes medical specialists from many fields who will help decide whether a liver transplant is your child’s best treatment option. They will also check to make sure that your child is healthy enough to have surgery. They will help you understand the treatment your child will need after a liver transplant and the cost of surgery, medicine, and ongoing care.

Tests may include:

• A physical exam
• Blood tests
• Heart, lung, and kidney tests such as X-rays and scans
• Tests of tissue types to find out what tissue will most closely match your child’s tissue

If a liver transplant is your child’s best option, your child’s name will be placed on a list of people waiting for a donor liver. There are not enough donor livers for everyone who needs one. The match is based on your child’s and the donor’s size and blood type, and on the severity of your child’s illness.

While waiting for a donor liver:

• Your child will continue to get treatment to help the liver work better.
• You will learn about the meal plan your child needs to follow and medicines your child will need to take after surgery.
• You will need to be available any time through a pager or a cellphone so the transplant center can contact you if a liver becomes available for your child.

Always keep a bag packed in case you are called. When a matching donor liver is found, you will be notified to take your child to the transplant center quickly. The transplant team will prepare for immediate surgery. The donor liver needs to be transplanted no more than 6 hours after its removal from the donor.

What happens during the procedure?

Your child will be given a general anesthetic to keep from feeling pain. General anesthesia relaxes your child’s muscles and puts your child into a deep sleep.

If your child is getting a liver from a deceased donor, the surgery will start when the organ is available. If your child is getting part of a liver from a living donor, your child and the donor will have surgery at the same time.

The healthcare provider will make a cut in your child’s belly. Your child’s diseased or injured liver will be removed, and the donor liver will be sewn in place. The new liver will begin working right away. Your child’s provider will close the skin with stitches. Some tubes will be left in your child’s belly to drain blood and fluid.

What happens after the procedure?

Your child will be in the intensive care unit (ICU) for the first few days. Most children are home within 2 weeks of surgery. How long your child will be in the hospital depends on:

• How healthy your child was before the transplant
• How soon the new liver is working well
• How your child’s body reacts to the new liver

Your child’s body will respond to the new liver as something foreign and may try to reject it. Some people who get transplants have some rejection. It usually happens during the first months after surgery but can happen any time after transplant.

To check for rejection, your child will have blood checks regularly after your transplant. If there is a concern about rejection, your child may have a biopsy. A biopsy is the removal of a small sample of tissue for testing. Your child will be given a local anesthetic so that your child will not feel any pain during the procedure. The provider will remove a tiny piece of liver tissue, usually with a needle.

Your child needs to take medicine to keep the body from rejecting the liver. Your child will take these medicines for the rest of his or her life. Your provider may change the dosage of the medicines, depending on biopsy results.

Carefully follow your child’s healthcare provider's instructions for taking medicines. Don’t miss any doses and don’t give your child more or less medicine or stop taking medicine without talking to your child’s provider first. Ask your child’s provider about nonprescription medicines and supplements before your child takes them.

Help your child:

• Stay up to date with the recommended immunizations (shots) for your child. Ask your healthcare provider about any vaccines your child or your family may need.
• Follow the meal plan recommended by your child’s provider.
• Avoid nicotine, alcohol, and any medicine not prescribed by your child’s healthcare provider.

Follow your healthcare provider’s instructions. Ask your healthcare provider:

• How long it will take your child to recover
• If there are activities your child should avoid and when your child can return to normal activities
• How to take care of your child at home
• What symptoms or problems you should watch for and what to do if your child has them

Make sure you know when your child should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• Your child may have problems with anesthesia.
• Your child’s body may reject the donor liver.
• Your child may have an infection, bleeding, or blood clots. The medicine to prevent rejection may weaken your child’s ability to fight infections. Infections can quickly become a serious problem.
• The medicine to prevent rejection may cause side effects such as high blood pressure, high cholesterol, kidney damage, small shaking movements of the arms and legs, and diabetes.
• Your child may develop emotional problems due to stress or the medicines your child takes.

Ask your healthcare provider how these risks apply to your child. Be sure to discuss any other questions or concerns that you may have.

For more information, contact:

• Scientific Registry of Transplant Recipients
  https://www.srtr.org/tools/waiting-list/
• US Department of Health and Human Services
  https://www.organdonor.gov/
• United Network for Organ Sharing
  https://unos.org/
  888-894-6361
• Organ Procurement and Transplantation Network
  https://optn.transplant.hrsa.gov/