Liver disease is a common and serious problem in our country. It is important for liver transplant patients and their families to understand the basic process involved with liver transplants, to appreciate some of the challenges faced by liver transplant recipients and to recognize symptoms that should alert them to seek immediate medical help.
Liver transplantation is the surgery to remove a diseased liver and replace it with a healthy one.
Children who suffer from end-stage liver disease due to various causes may be considered for liver transplantation. The most common indication in children is Biliary Atresia.
Eligibility is determined by a comprehensive medical evaluation by the transplant team.
There are two sources: cadaveric and living donors.
The advantage of living related donor transplant is that the procedure can be scheduled effectively so that it works best for the donor and recipient. The disadvantage is that there is a very small risk of complications to the donor. Out of the 40 pediatric living related liver transplants performed at our center, there has been no significant complication in the donor population.
Most donors are hospitalized for 7-10 days after surgery. The incision staples are usually removed about 7-10 days postoperatively.
The recovery time for this type of surgery varies, but most donors are advised that they will require up to 3 months for complete recovery of normal health and activity.
This consist of checking all the body systems with regards to optimal function and presence of unexpected disease. The child’s immunization records will be reviewed. Following transplantation, some vaccines cannot be given and others may not be as effective.
A detailed nutritional assessment will also be performed. Several tests will be performed:
A typical liver transplant can last from 8-12 hours. The surgery for the donor lasts approximately 5-6 hours.
There are risks with transplant surgery just as with any major surgery. Some immediate complications can include bleeding and blood clotting problems, respiratory problems and malfunction of the donor liver. Long term complications include rejection (when the child’s immune system does not accept the new liver) and infection. Fortunately, most of these complications are treatable.
After the surgery, your child will be taken to the Transplant ICU where he/she will stay for a week. Once the child is transferred out of ICU to the pediatric floor, the length of stay will depend on how quickly he/she recovers. Average length of hospital stay is about 3 weeks.
The child will take 2 major types of medications in addition to multivitamins and health supplements to prevent rejection. If the child misses a dose, please contact our team immediately.
Initially the child has to come to the transplant clinic twice a week for laboratory work up and physical examination or as frequently advised by our team. As recovery progresses, these visits become less frequent.
The child will be looked after by the primary pediatrician who will be supported by our team. Reports will be communicated to us via e-mail or fax.
For the first six weeks after surgery, the child should avoid strenuous exercises.
Most patients can return to a normal or near-normal lifestyle, six months after a successful liver transplant. Recipients should avoid exposure to people with infections. Maintaining a balanced diet and staying on prescribed medications are vital to stay healthy. Children can attend school and participate in sports and other age-appropriate activities and can have a normal married life with no fertility issues.
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