The transplant is required when the liver is so badly and irreversibly damaged that only a new healthy liver offers any chance for the child’s long-term survival.
Some of the more common ones are:
Metabolic liver disease
Acute hepatic necrosis (death of liver tissue) due to:
Cirrhosis - a chronic problem that impairs the liver's ability to remove toxins (poisonous substances) from the body
Cholestatic liver disease
Liver tumors, both malignant and benign (noncancerous)
Other diseases and conditions
Before final selection and listing for liver transplantation, the child undergoes a multidisciplinary pretransplant evaluation to determine the current status of the liver disease and the extent of its progression. All outside medical records, radiological studies, and liver biopsy materials are reviewed. The transplant hepatologist, and surgeons do consultations. Blood tests may include
Imaging studies and other tests
After these assessments and tests are completed, our team of experts meets with the family and discusses all treatment options.
There are two sources: living donors and recently deceased donors.
Deceased donors are individuals whose organs have been made available for donation at their own request before death or by their families after death. The types of deceased-donor transplants include:
Full graft liver transplantation - The entire liver from a deceased donor is transplanted to a recipient of similar body size.
Reduced-size liver transplantation - A liver from a larger donor is trimmed to fit a smaller recipient.
Split liver transplantation - A large liver is split and shared between a small adult (right lobe) and a child (left lobe).
Unfortunately deceased donor organs are available only rarely in the Indian subcontinent and across most of Asia.
For more information on living donor click here (should link to the section of live donor living transplant under transplant operation)
One of the advantages of living-donor transplantation is that the procedure can be scheduled at a time that works best for both donor and recipient. For the donor, the major issue is his or her work and family schedule. For the recipient, the principal constraint is health condition and control of complications. For example, if the recipient develops a sudden fever, the procedure will be delayed until the cause is found and any potential infection controlled.
The length of hospitalization will vary, depending on the individual patient. A typical hospital stay for school-age children is 14 to 18 days.
Patients are placed on immunosuppressive drugs to prevent rejection of the transplanted liver. Since patients on immunosuppressant are vulnerable to bacterial and viral disease, they are monitored for signs and symptoms of infection.
The transplant team also monitors the child for signs of bleeding and other potential postoperative complications. Rarely, a patient will have to return to the operating room for evaluation and treatment of a postoperative complication.
Initially, the patient visits the Clinic twice a week for laboratory work and physician examinations. As recovery progresses, these visits become less frequent. Our team will continue to be a part of follow-up care even after the patient is able to return home.
Only a part of the liver is removed for transplantation. The remaining liver grows rapidly within 6 to 8 weeks. The feasibility of living donation was first demonstrated in 1989. Since then more and more Living Related Liver Transplants (LRLTs ) are being performed the world over. Donors experience very few complications. The Centre for Liver &Biliary Surgery (CLBS ) at Max Super Speciality Hospital, Saket has been performing living-donor transplants with excellent results .
A potential donor is a relative who is healthy and fit with no major health concerns, between 18 and 55yrs in age, and free from:
Other factors are also important in selecting a donor:
Acceptable combinations are
The anatomy and size of the liver must be suitable to ensure donor safety as well as to determine if it will be adequate for the recipient.
Once it is determined that the ABO blood type is compatible, the candidate will have additional tests which include a complete blood count, liver and kidney function tests, and blood tests for hepatitis B and C and HIV.
If the laboratory results confirm that the candidate is suitable as a donor, a chest x-ray and electrocardiogram (ECG) are done to make sure that he or she can safely receive anesthesia.
If the blood tests work, ECG, and x-ray are within normal limits, a volumetric CT scan calculates the volume of the liver to determine whether the portion being donated will fit the recipient. A psychiatrist then does a comprehensive psychological evaluation to make sure that the candidate understands the risks of the procedure, is donating from his or her own free will, and has adequate support to be cared for after surgery.
An Echocardiography, a Lung Function Test, Thyroid function tests and an MRI of the Biliary tree complete the donor evaluation.
The donor usually spends 7 - 10 days in the hospital. Most patients are up and out of bed by the second or third postoperative day. The donor usually needs to stay off work for a month full-time and maybe a further two to four weeks part-time, depending upon rapidity of recovery.