Liver Transplant

Liver Transplant

Signs and Symptoms
Evaluation
Treatment

Treatment

Liver transplantation may be a treatment option for children with end stage liver disease. Transplant livers may come from a cadaveric donor who has died, or from a living donor. To receive a cadaveric donor, the patient is put on a national waiting list until a donor becomes available. This can occur at any time, day or night. The wait is generally two to three years.

A live donor is usually someone in the family or a close family friend. Living-donor liver transplantation allows physicians to do the transplantation without the sometimes lengthy wait for a cadaveric liver. Both donor and recipient livers grow and remodel after the transplant. During the transplant evaluation, live donation is discussed with the parent. Donor safety is of primary concern throughout the process. Donors must be in good health, be of a compatible blood type to the recipient and be motivated to donate from altruistic reasons. If this is a feasible option, a donor evaluation will be started after all the recipient's testing is completed. If the transplant team determines the donation would work, a surgery date is scheduled for both the donor and recipient. This process usually takes up to six months.

Your child's surgery may last from 4 to 12 hours depending on his or her condition.

During surgery, your child's old liver and gallbladder will be removed and replaced with the donor liver. Since a gallbladder is no longer required, a new one will not be transplanted.

After surgery, your child will go directly to the intensive care unit (ICU), usually for one or two days. Immediately after surgery, a breathing tube will be inserted to help him or her breathe. In most cases the tube can be removed within 24 hours after surgery. Many monitoring lines also will be attached; these, too, will be removed as your child becomes more stable. When your child is ready to leave the ICU, he or she will be cared for on either the 6th or 7th floor of  the Long wing of the hospital.

Everyone recuperates from liver transplantation differently. Depending on your child's condition, he or she will be hospitalized for two to eight weeks following the transplant.

In general, most children stay within the San Francisco Bay Area for two to six weeks after transplant and then are referred back to their primary provider and referring physician. Our social workers assist families with housing and there is a San Francisco-based Ronald McDonald House. Once the child has returned home, we work with your primary doctors to ensure that your child receives optimum care regarding their liver transplant as well as issues related to normal growth and development.

Laboratory blood tests are obtained twice a week following transplantation; the frequency of blood tests is gradually reduced over time. You will be asked to call in test results to the transplant office. You will then be notified about any adjustments in your child's medications.

Complications can occur with any surgery. Patients undergoing organ transplants may face additional complications. The life-threatening disease that created the need for your child's transplant may affect the functioning of other body systems. Other risks, such as rejection, also may occur.

Some possible transplant complications and medication side effects include:

• Hemorrhage: One function of the liver is to manufacture clotting factors. When a liver fails, the ability to produce clotting factors is impaired. To correct this problem, your child will receive blood products before and after surgery. It is expected that your child's new liver will start working very quickly to help prevent any excessive bleeding, but it is possible that he or she may be returned to surgery to control the bleeding, particularly if it occurs within the first 48 hours after transplant.
• Thrombosis: If a blood clot forms in a vessel leading to or from your child's liver, this may injure the new liver. Your child will receive special anticoagulation medication to prevent this. This is a serious complication that may require a second transplant.
• Rejection: Your child's defense system --  the immune system -- protects him or her from invading organisms. Unfortunately, it also views the new liver as foreign and will try to destroy it in an attempt to protect your child. This is known as rejection. To prevent this from occurring, your child will be given special immunosuppressive medication that must be taken for the rest of his or her life. Rejection can be diagnosed early by performing weekly liver biopsies during the first few weeks after liver transplant. Although rejection is common, with early diagnosis and treatment the situation can be controlled in more than 95 percent of cases.

Immunosuppressive medications help to prevent and treat rejection. These drugs decrease your child's resistance to foreign bodies, such as the new liver. Your child will need to take these medications for the rest of his or her life or the liver will be rejected. Immediately after surgery, the dosages will be high since the probability of rejection is greatest at this time. Dosages will be lowered quickly to smaller amounts if there are no signs of rejection.

The medications have side effects, which are usually dose-related. Most people experience the highest level of side effects in the beginning when medication dosages are high. As the dosage is lowered, these effects will probably lessen. Side effects may occur in some patients and not in others.

The medications your child will take for rejection also impair his or her ability to fight off infections. Your child will be given medication to help prevent infections but you also will need to use caution and avoid contact with people with infections, especially during the first three to six months after transplant.

In the future, alternative therapies such as artificial liver assist devices, techniques of cellular transplantation, and genetic modification of hepatocytes may become viable approaches to managing children with end stage liver disease.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated May 8, 2007