What is liver transplant?

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Liver transplant in children: Overview

A liver transplant is surgery to give your child a healthy liver from another person. Your child may get a whole new liver or just part of a new liver. The new liver may come from someone you know. Or it may come from a stranger or a person who has died. If your child is waiting for a liver from a non-related donor, your child will be placed on a national waiting list until a new liver becomes available. The wait can be for as long as a few years. During that time, your doctor will update the transplant team about your child's condition. When you get a call from the transplant team, you'll need to bring your child to the hospital right away.

To do the surgery, the doctor makes a cut (incision) in your child's upper belly. Then the doctor removes the liver. Next, the doctor connects the blood vessels of the new liver to your child's blood vessels. The doctor also connects the bile duct of the new liver to your child's bile duct. Then the doctor closes the incision with stitches or staples. The stitches may be the type that dissolve in the body over time. If not, the doctor will take them out a few weeks after surgery. The incision will leave a scar that will fade with time.

After surgery, the new liver will start to do the work that your child's old liver could not.

Your child will probably spend at least a couple of weeks in the hospital. Your child will go back for frequent checkups for about a month after that. Most children are able to go back to school in about 2 to 3 months. Your transplant team will give you a follow-up schedule.

Liver transplant

A liver transplant is a surgical procedure that removes a severely diseased liver and replaces it with a healthy liver from an organ donor.

Conditions that can destroy the liver include long-term alcohol use, viral hepatitis, liver cancer, and other diseases.

After receiving a transplant, a person will need to take medicines the rest of his or her life to suppress the immune system and prevent rejection of the new organ.

Not everyone is a candidate for liver transplant. The person must be in good health apart from the liver disease, be free from drugs and alcohol, and be young enough for the possibility of a long life when healthy. The person must also be free from significant psychological disorders (such as severe depression) and be able to pay for the expensive procedure.

How can you care for your child after a liver transplant?

Activity

  • Have your child rest when he or she feels tired.
  • Allow your child's body to heal. Don't let your child move quickly or lift anything heavy until he or she is feeling better.
  • Have your child hold a pillow over the incision when he or she coughs or takes deep breaths. This will support the belly and decrease pain.
  • If your child is a teen, ask your doctor when he or she can drive again.
  • Many children are able to return to normal activities within 2 to 3 months after surgery.
  • Your doctor will tell you when your child can bathe or swim after surgery.

Diet

  • Follow your doctor's instructions about what your child can eat after surgery. Most children start eating a regular diet over time after the transplant.
  • If your child's bowel movements are not regular after going home, you can help him or her to avoid constipation and straining. Have your child drink plenty of water. The doctor may suggest fiber, a stool softener, or a mild laxative.

Medicines

  • Your doctor will tell you if and when your child can restart his or her medicines. The doctor will also give you instructions about your child taking any new medicines.
  • Give your child anti-rejection medicines exactly as prescribed. Call your doctor if you think your child is having a problem with the medicine.
  • If your child needs antiviral or antifungal medicines, give them as directed.
  • Be safe with medicines. Read and follow all instructions on the label.
    • If the doctor gave your child a prescription medicine for pain, give it as prescribed.
    • If your child is not taking a prescription pain medicine, ask the doctor if your child can take an over-the-counter medicine. Do not give your child acetaminophen (Tylenol) unless your doctor tells you it's okay.

Incision care

  • Your child will have a dressing over the cut (incision). A dressing helps the incision heal and protects it. Your doctor will tell you how to take care of this.
  • Keep the area clean and dry.

How well does a liver transplant work in children?

Most children can have a good quality of life after their transplant. The success of a liver transplant may depend on:

  • Taking your child to all follow-up appointments, getting all their tests, and calling your doctor if your child has problems.
  • Your child's overall health. After the transplant, it's important for your child to keep a healthy lifestyle. This includes eating healthy foods and being active.
  • Whether your child takes medicines as prescribed. Most people take anti-rejection medicines every day for the rest of their lives.
  • Finding and treating organ rejection early. This makes it more likely that the transplanted liver will stay healthy. That's why it's important to go to follow-up appointments and get tests.
  • The disease that caused your child's liver to fail.

How do you prepare for your child's liver transplant?

Surgery can be stressful for both your child and you. This information will help you understand what you can expect. And it will help you safely prepare for your child's surgery.

Preparing for surgery

  • Follow the transplant team's instructions about giving your child healthy foods while your child is on the waiting list. Good nutrition can help make the surgery more successful.
  • Keep a bag packed for you and your child so you'll be ready to go to the hospital when a liver becomes available.
  • Understand exactly what surgery is planned, along with the risks, benefits, and other options.

What are the risks of a liver transplant?

Like any surgery, a liver transplant has some risks. Risks include:

  • Organ rejection. The body sees the new liver as foreign and tries to destroy it. This happens because the donor liver doesn't match the body's tissue exactly.
  • Problems such as bleeding during and after the surgery.
  • Infection. The medicines that help fight organ rejection can also make it harder for the body to fight infection.
  • Certain cancers, such as skin cancer. This risk increases because anti-rejection medicines can also prevent the body from attacking cancer cells.

After your child's liver transplant: When to call

Call 911 anytime you think your child may need emergency care. For example, call if:

  • Your child has trouble breathing.
  • Your child passes out (loses consciousness).
  • Your child has chest pain, is short of breath, or coughs up blood.
  • Your child has severe belly pain.

Call your doctor now or seek immediate medical care if:

  • Your child has a fever.
  • Your child has symptoms of infection, such as:
    • Increased pain, swelling, warmth, or redness.
    • Red streaks leading from the area.
    • Pus draining from the area.
  • Your child's body shows signs of rejecting the new liver, such as:
    • Pain or swelling in the belly.
    • Sudden weight gain.
    • The skin or the whites of the eyes turn yellow.
    • Dark urine.
    • Headache, crankiness, or lack of energy.
  • Your child has pain that does not get better after he or she takes pain medicine.
  • Your child has loose stitches, or the incision comes open.
  • Your child is bleeding through the bandage.
  • Your child can't drink fluids.
  • Your child has any problems with any of his or her medicine.

Watch closely for changes in your child's health, and be sure to contact your doctor if you have questions.

What can you expect as you recover from a liver transplant?

You will be cared for in the intensive care unit (ICU) for a couple of days after surgery. Then you will probably spend 1 to 2 weeks in the hospital. Most people are able to go back to work in a couple of months. But it depends on the type of work you do and how you feel. It may take 2 to 4 months for your energy to fully return.

After surgery, the new liver should start to do the work that your diseased liver could not.

After the transplant, you will take medicine to keep your body from rejecting the new liver. You will most likely need to take this anti-rejection medicine every day for the rest of your life. These medicines have side effects. One side effect is that your body may be less able to fight infections.

It's important to take steps to avoid infections from now on. Be careful in public places and crowds of people. Stay away from anyone who might have an infection or an illness such as a cold or the flu. You may have to call your doctor anytime you have a fever.

Getting support

Having good support is important throughout the process of getting a transplant. Waiting for your transplant can be hard emotionally. After your surgery, you may have concerns about your health and the new organ you received. You'll also have a lot to manage, like taking new medicines and going to follow-up visits.

Getting support from others, such as friends and family, can help during this time. A counselor can help you learn to cope with stress and other emotions before and after your surgery.

Many people who have an organ transplant feel anxious or depressed. Talk to your doctor if you think you may be depressed. Depression can be treated with medicines and counseling.

After your child's liver transplant: Overview

A liver transplant is surgery to give your child a healthy liver from another person. Your child may have received a whole new liver or just a section of a new liver.

Your child's belly and side will be sore for the first 1 to 2 weeks after surgery. There may also be some numbness around the cut (incision) the doctor made. It is common to feel tired while healing. It may take 2 to 4 months for your child's energy to fully return.

After the transplant, your child must take medicine to keep the body from rejecting the new liver. These anti-rejection medicines have side effects. One side effect is that the body may be less able to fight infections. You can talk with the doctor about ways to lower your child's chance of getting an infection.

You and your child will have to stay close to the hospital for about a month. Your child will have frequent checkups during that time. Your child's medicines may be changed as needed.

Having a child who is getting an organ transplant can bring up many emotions. Seek out family, friends, and counselors for support. If you think that you or your child is depressed, ask your doctor for help. Treatment can help you and your child feel better.

Living-Donor Liver Transplant

Picture of living-donor liver transplant

For a living-donor liver transplant, a healthy person donates a portion of his or her liver to the transplant recipient. The recipient's liver is removed and replaced with this part of the donor's liver. The recipient's and donor's surgeries are carried out at the same time in different operating rooms.

Both the portion of the liver remaining in the donor and the portion donated will grow back to normal size.

Why is a liver transplant done in children?

Your child may need a transplant if their liver doesn't work as it should. This is often because of damage from blocked bile ducts, a genetic problem, or a tumor. A transplant may be needed because of sudden (acute) failure, such as from an overdose of acetaminophen (Tylenol).

What happens on the day of your child's liver transplant?

  • Follow the instructions exactly about when your child should stop eating and drinking. If you don't, your child's surgery may be canceled. If your doctor told you to have your child take any medicines on the day of surgery, have your child take them with only a sip of water.
  • Do not let your child wear contact lenses. Bring your child's glasses or contact lens case.
  • Be sure your child has something that's a reminder of home. A special stuffed animal, toy, or blanket may be comforting. For an older child, it might be a book or music.

At the hospital or transplant center

  • A parent or legal guardian must accompany your child.
  • When you arrive at the hospital or transplant center, your child will be prepared for surgery right away. Final tests will be done to make sure that your child is ready and that the donor organ will likely work for your child.
  • Your child will be kept comfortable and safe by the anesthesia provider. Your child will be asleep during the surgery.
  • The surgery will take several hours.
  • After surgery, your child will stay in the pediatric intensive care unit (PICU) for 2 to 3 days or more. The amount of time will depend on your child's condition. The staff will watch your child's condition. The doctor will talk to you about the surgery.
  • A ventilator may be needed to help your child breathe after the surgery.

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