Liver transplant is conducted when the condition is severe or chronic, and all the other options have been exhausted. Patients with acute or chronic liver failure undergo this surgery. Fortunately, most of the surgeries have a high success rate. Many kids who undergo this surgery live a normal and healthy life.
A proper long-term care with medications and regular follow-up for liver functioning is suggested. If surgery is the only option given by hepatobiliary surgeon, following are some important steps to evaluate and take care of your child.
1.Evaluation of the patient:
Liver transplant surgery for a child is usually recommended with the liver condition which is undoubtedly incurable with medications. Acute liver failure, viral hepatitis, autoimmune hepatitis are some of the condition, where a transplant is recommended. The evaluation period can be both stressful and time-consuming. But a great medical team should keep you at ease. As a parent, you should actively help and support the child and medical team.
2.Pre-surgery period
The severity of the liver decides the transplant procedure. A thorough check-up is followed by the team of the doctors working on the surgery for both donor and patient. The assessment will include physical examination, blood tests, chest X-ray, ultrasound and CT scan are done for studying the exact condition. About 50% of the pediatric patient who needs a transplant have Biliary Atresia (Atresia is a condition where an orifice or passage in the body is closed or absent).
Other diseases which may account for end-stage liver disease among pediatrics are Wilson disease, hemochromatosis, metabolic disorders related to hepatic dysfunction which are:
• Glycogenosisrn• Family hypercholesterolemiarn• Hyperoxaluriarn• Crigler-Najjar syndrome.
rn3.Waiting phase
Once a suitable candidate is available for the transplant, the patient’s name is placed on the waiting list for the organ. The waiting list time varies for each child based on the donor availability, and the Pediatric End-Stage Liver Disease score for children under 12 is taken to prioritize the waitlist. According to the PELD, higher score means severe liver disease hence allowing the sicker patient to jump the waitlist.
Sadly, there will be many other potential recipients who are looking for the transplant. Various transplantation centers have a disciplinary committee to make a decision on the waiting list. Reviewing all the factors such as severity of the patient, the hepatic condition, non-hepatic condition of the patient, substance abuse problem if any, and psychological stability is taken into consideration by the committee.
4.Surgery
A liver or portion of a liver transplant is decided by the doctor after reviewing the patient’s condition. A team of Pediatric Hepatologist, Hepatobiliary Surgeon, Anesthesiologists, Nurse Practitioner, Pharmacy Clinical Specialist, Nutritionist and Social workers work in succession till the patient’s recovery. If the donor is deceased the surgery has to be performed within 12-18 hours while in case of living donors, general anesthesia is given, and immediate surgery is performed.
5.Postsurgical care
As a parent, you will be under a lot of stress and trauma. Spending more family time and giving more attention to the child will help reduce the anxiety. To minimize the risk to the patient, following are some tips to follow-
• Post-surgery, as a parent, you must follow all the instructions carefully. There will be a combination of immunosuppressive medications for recovery. These are given to prevent rejection which can suppress the immune system.
• Like all medications, immunosuppressant too has some side effects, it reduces body natural ability of defense against foreign bodies, thus chances of infection increases.
• Approximately 12 weeks are required for returning to normal daily life. In between, monitor the child’s medications and their side effects; if you find anything wrong, consult a doctor or pharmacist.
• Rejection is another crucial and lifelong concern. A routine checkup such as physical examination, blood tests, ultrasound, etc. can be helpful in long run. According to the degree of rejection, medications are prescribed.
• Surgical complications are rare, but sometimes one of the blood vessels from the donor to the patient isn’t connected the way it should be. There can be a blood clot formed in the major blood vessel supplying blood to the liver. A close follow-up is mandatory in all the post-surgical pediatric patients.
To know more about your specific condition, please visit an
Hepatologist in a trusted hospital close to you.