Frequently Asked Questions

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:

Congenital abnormalities

• Extrahepatic biliary atresia
• Sclerosing cholangitis

Metabolic liver disease

• Alpha-1-antitrypsin deficiency
• Wilson’s Disease
• Tyrosinemia
• Glycogen storage diseases
• Hyperoxaluria
• Crigler-Najjar type II
• Hyperammonemic syndromes

Acute hepatic necrosis (death of liver tissue) due to:

• Toxins
• Drugs
• Viral infections
• Unknown causes

Cirrhosis – a chronic problem that impairs the liver’s ability to remove toxins (poisonous substances) from the body

• Autoimmune – cirrhosis resulting from the body’s immune system attacking the liver
• Cryptogenic – cirrhosis that has an uncertain cause

Cholestatic liver disease

Liver tumors, both malignant and benign (noncancerous)

Other diseases and conditions

Congenital hepatic fibrosis

• Caroli Disease
• Cystic fibrosis

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

• Chemistry panel
• Liver panel
• Hematology group
• Coagulation studies
• Blood typing and antibody screen
• Infectious diseases: hepatitis serologies, HIV, cytomegalovirus

Imaging studies and other tests

• Ultrasound of the liver
• Liver biopsy (optional)

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 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 donors, 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 donors, the major issue is their work and family schedule. For the recipient, the principal constraint is a 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 immunosuppressants make patients vulnerable to bacterial and viral diseases, 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 will a patient have to return to the operating room to evaluate and treat 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 provide 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 ) have been performed worldwide. 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:

• HIV infection
• Chronic viral hepatitis
• Active alcoholism or heavy alcohol use
• Psychiatric illness under treatment
• History of malignancy
• Any other serious chronic medical illness

Other factors are also important in selecting a donor:

• The donor should be a relative (close or distant)
• The donor must be mentally sound and freely willing to donate.
• No financial gain should result from the donation as it is illegal.
• The donor’s blood type must be compatible with the recipient’s.

Acceptable combinations are

• • A/O to A
  • B/O to B,
  • O to O, A/B/AB/O to AB.
  • Positive or negative blood types are of no importance in liver transplantation.

The anatomy and size of the liver must be suitable to ensure donor safety and to determine whether 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 performed to ensure that he or she can safely receive anesthesia.

If the blood tests work, ECG and X-rays 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 ensure 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.

The donor evaluation includes echocardiography, lung function tests, thyroid function tests, and an MRI of the biliary tree.

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 two to four weeks more part-time, depending upon the rapidity of recovery.