A liver transplant is surgery to replace a diseased liver with a healthy liver from another person.
The new liver may come from an organ donor who has just died. Or part of a liver may come from a healthy living person. This is called a living donor. A living donor may be a family member. Or it may be someone who is not related to your child but has a matching blood type.
People who donate part of their liver can have healthy lives with the liver that is left. The liver is the only organ in the body that can replace (regenerate) lost or damaged tissue.
The donor’s liver will soon grow back to normal size after surgery. The part that your child receives as a new liver will also grow to normal size in a few weeks.
A liver transplant is recommended for children who have serious liver problems and will die without a new liver. The most common liver disease in children who need transplants is biliary atresia. This is a rare disease of the liver and bile ducts that occurs in newborns.
Other conditions may include:
Possible complications from liver transplant surgery may include:
Rejection is a normal reaction of the body’s immune system, or disease-fighting system, to a foreign object or tissue. When a new liver is placed in your child’s body, the immune system thinks it is a threat and attacks it.
To help the new liver survive in your child’s body, your child must take anti-rejection medicines. These are called immunosuppressants. These medicines weaken the immune system’s response. Your child must take these medicines for the rest of his or her life.
If your child’s provider thinks he or she may be a good candidate for a liver transplant, the provider will refer your child to a transplant center for evaluation. Transplant centers are located in certain hospitals throughout the U.S.
Your child will meet the transplant center team. The team will decide whether to place your child’s name on a national transplant waiting list. The transplant center team will include:
You child must have a full evaluation before he or she can be placed on the transplant waiting list. The transplant center team will do many tests, including:
The transplant center team will look at all of your child’s test results and information. Each transplant center has rules about who can have a liver transplant.
Your child may not be able to have a transplant if he or she:
If your child is accepted as a transplant candidate, he or she will be placed on a national transplant waiting list. People who most urgently need a new liver are put at the top of the list. Your child may be on the waiting list only a few days or weeks before receiving a donor organ. But if no living related donor is found, your child may have to wait months or years. During this time, your child will have close follow-up with his or her provider and the transplant team. Support groups are also available to help you during this waiting time.
You will be contacted when a liver is available because a donor has died. You will need to go to the hospital right away so your child can get ready for surgery.
If the liver is from a living donor, the surgery will be planned in advance. Your child and the donor will have surgery at the same time. The donor must be in good health. He or she must have a blood type that is a good match with your child’s blood type. The donor will also take a psychological test. This is to be sure he or she is comfortable with this decision.
Once a liver is available for your child, you and your child will be told to go to the hospital right away. This call can occur at any time, so you should always be ready to go to the hospital. At the hospital, your child will have some more final blood work and tests to be sure the liver is a match.
Your child will then go to into surgery. The transplant may take several hours. This will vary depending on your child’s case. During the surgery, a member of the transplant team will let you know how the surgery is going.
Liver transplant surgery requires a hospital stay. Procedures may vary. It depends on your child’s condition and the provider’s practices.
Generally, a liver transplant follows this process:
After the surgery, your child will go to the intensive care unit (ICU) to be watched closely. The length of time your child will spend in the ICU will vary. It is based on your child's condition.
After your child is stable, he or she will be sent to the special hospital unit that cares for liver transplant patients. Your child will still be watched closely. During this time, you will learn all about caring for your child. This will include information about medicines, activity, follow-up, diet, and any other instructions from your child's transplant team.
Your child's body may try to reject the new liver. Rejection is a normal reaction of the body’s immune system, or disease-fighting system, to a foreign object or tissue. When a new liver is placed in your child’s body, the immune system thinks it is a threat and attacks it.
Rejection is more likely to occur 1 or 2 weeks after surgery. But rejection can occur at any time that anti-rejection medicines are not able to control the immune system response.
It may not always be easy to tell when rejection occurs. High liver enzyme levels in the blood may be the first sign of rejection.
It is important for both you and your child, when he or she is old enough, to know the signs and symptoms of rejection. Symptoms may vary. Some common symptoms of rejection may include:
The symptoms of rejection may seem like other health problems. Your child's transplant team will tell you who to call right away if any of these symptoms occur.
Your child must take anti-rejection medicines for the rest of his or her life. The doses of these medicines may change often, depending on your child's response. Each child may react differently to medicines. And each transplant team may prefer different medicines.
Your child will have blood tests from time to time. These will measure the amount of medicine in your child’s body. This is to make sure your child gets the right amount of medicine. White blood cells are also an important sign of how much medicine your child needs.
Anti-rejection medicines affect the immune system. So children who have a transplant are at greater risk for infections. This risk is very high in the first few months after surgery. That’s because higher doses of anti-rejection medicines are given during this time.
For the first few months after surgery, your child should avoid crowds or anyone who has an infection.
Your child will most likely need to take medicines to prevent other infections from occurring. Some of the infections your child will be at greater risk for include:
Living with a liver transplant is a lifelong process. Your child will have to take anti-rejection medicines so that the immune system won’t attack the new liver. Other medicines must be given to prevent side effects of the anti-rejection medicines. These side effects include infections. It’s important that you and your child keep in close contact with the transplant team.
When your child is old enough, he or she will need to learn all about anti-rejection medicines and what they do. Your child will have to learn the signs of rejection, and everything else you have learned. This is important so that your child can one day care for himself or herself without help.