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Pediatric Liver Transplant

  • Posted on- Jun 24, 2017
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Pediatric Liver Transplant

Pediatric liver transplant is ordered for children's, whose liver may fail to work properly. The most common cause of liver transplant is biliary atresia or cirrhosis. There may be some other reasons also, such as hemochromatosis, Wilson's disease, Alagille syndrome etc.

Pediatric patients account for about 12.5% of liver transplant recipients. When a pediatric patient is likely to have a liver transplant, the medical team is usually divided into pre-transplant and post-transplant sections, with the post-transplant period further separated into early and late time frames.

Pre Pediatric Liver Transplantation Care

Pre-transplantation care needs to take into consideration potentially prolonged waiting periods and to project far in advance when transplantation might be required. By starting the pre-transplant workup early, one can work toward maximizing the nutritional status.

Nutritional status impacts both pre-transplant and post-transplant outcomes, especially in the pediatric population, because of an increased incidence of cholestatic liver diseases. Cholestatic liver diseases further lead to fat mal-absorption, which causes a deficiency of calories as well as fat-soluble vitamins.

Pediatric patients can greatly benefit from caloric assessments and supplemental tube feedings as indicated. Furthermore, parental feedings are sometimes warranted in the most nutritionally deprived patients with end-stage liver disease.

Neonatal liver transplantation

Liver transplantation has been successfully extended to neonates. Acute liver damage from hemochromatosis leading to a histologic treatment of giant-cell hepatitis is the primary indication for liver transplantation in the neonatal population. Because of size difference between the recipient and the donor, partial liver grafts are usually used for this population of patients.

Although neonates seem to be more immunotolerant to transplanted organs, their immature immune systems relates with immunosuppression increases the risk for infectious complications.

Indications for pediatric liver transplantation

About 50% of the pediatric patients who require a liver transplant have biliary atresia. Other disorders states that progress to end stage liver disease among pediatric patients and require liver transplantation include metabolic disorders and progressive intra hepatic cholestasis.

Examples of metabolic derangements consist of Wilson disease, alpha 1-antitrypsin deficiency, tyrosinemia, and hemochromatosis. Other metabolic disease states leading to hepatic dysfunction include the following:

•    Crigler-Najjar syndrome
•    Glycogenosis
•    Hyperoxaluria
•    Metabolic respiratory chain deficiencies
•    Familial hypercholesterolemia
•    Methylmalonyl aciduria

Who can donate liver?

Parents of the child who need transplant, his/her close relative or any other living person or brain dead (deceased)person whose family wish to donate liver, can donate liver to the child patient. Blood compatible between the donor and recipient is needed, but if it's not possible, swab transplantation technique can be used.

Q. Liver can be donated by whom?
A. An Individual who wants to donate the part of their liver, whether it may be of child's parents, his close relative or any other person can donate liver or a brain dead person whose family wants to donate his liver. If the blood type is not compatible between donor and recipient, technique known as swab transplantation is used.

Q. Liver can be donated with a motive of?
A. The person who is donating liver to a child patient must donate of his own free will without financial motivation.

Q. What is the eligible age to donate liver?
A. The age which is eligible to donate liver for swap liver transplantation is 18 - 55 years.

Q. Who is compatible for liver transplant?
A. The blood groups and the HLA profiles of the recipient and the deceased donor must match with each other. But if the profiles don't match another technique known as swab transplantation may be used.

Tests during pre-liver transplantation
There are various tests which are prescribed by doctors to surgeon during pre-liver transplantation. Tests which are prescribed by doctors are as follows:

Laboratory Tests
Laboratory tests are prescribed by doctors to assess the health of the organs of a living donor or a deceased donor, including the liver, which includes blood tests, urine tests.

Imaging tests
Imaging tests are prescribed by doctors which are Ultrasound, CT scan, MRI of the liver and other abdominal organs.

Heart tests
Heart tests are prescribed by doctors to determine the health of the living donor or deceased donor cardiovascular system.

Cancer Screening
A routine cancer screening is a general health exam to evaluate overall health of a donor.

Psychological Evaluation

Psychological evaluation is prescribed by doctors to determine whether you fully understand the risks of a Liver Transplant.

Addiction counseling
Addiction counseling is prescribed to help people with alcohol, drug or tobacco addictions to quit.

Precautions taken post-liver transplant surgery

There are some precautions which are to be taken by the donor as well as recipient. Precautions which are to be taken by the donor and recipient are as follows:

•    The donor must stay under observation post-liver transplant surgery in hospital for 2-3 weeks.
•    At home, 2-3 weeks of recuperation for donor is needed after discharging from hospital.
•    A donor can resume his/her normal activity 6-8 weeks post-liver transplant surgery.
•    Children receiving liver transplantation need routine follow-up checkups throughout their life time at timely intervals.

Comments

user profile image
15-03-2018 12:11 PM

When my son was few months old, he was diagnosed with biliary atresia (liver disease). After sometime, liver was fully failed and needed a transplant. Liver Transplant was performed and my son is living a happy life.

user profile image
15-03-2018 12:03 PM

My daughter was diagnosed with chronic liver disease and portal hypertension when she was 1 year ago. In 2010, she went through a live donor liver transplant, the donor being her father.

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