FAQ's on Pediatric Liver Transplantation

Q- What is liver transplantation?

Ans- Liver transplantation is a surgery done to remove a diseased liver and replace it with a healthy one.

Q- Who is a candidate for liver transplant?

Ans- Children who suffer from end-stage liver disease from varying causes may be considered for liver transplantation. The most common indication in children is biliary atresia. Liver Transplant is life saving in acute liver failure and a few metabolic disorders that otherwise carry a high mortality risk.

Q- How is it decided that my child needs a liver transplant?

Ans- Eligibility is determined by a comprehensive medical evaluation by the transplant team.

Q- Who can be the donor for transplantation?

Ans- There are two sources: deceased and living donors.

Deceased donors are individuals whose organs have been made available after brain death. As this option is scarce in India, living related liver transplantation is the only feasible option in our country.

For living related transplants, a related donor (usually parent) with a compatible blood type donates a portion of their liver to the child. Fortunately, the liver of the donor is able to grow back to its full size in 8-12 weeks. Living liver donors should be healthy, with a near normal body mass index (not obese) adults who have the ability to understand the procedure.

The donor should have no medical, emotional, or psychological impairments that could potentially increase the risk of the surgery

Q- What does a pre-transplant evaluation process consist of?

Ans- This consists of checking all the body systems with regards to optimal function and presence of unexpected disease. Your child's immunization records will be reviewed. Following transplantation, some vaccines cannot be given and others may not be as effective. A detailed nutritional assessment will also be performed. Several tests will be performed:

Laboratory blood and urine tests

Electrocardiogram (ECG) and a Chest X-ray, Echocardiography

Ultrasound of the liver and blood vessels

CT angiography abdomen

HLA testing for establishing a relationship between the donor and recipient.

Q- What are the pros and cons of living donor transplantation?

Ans- The advantage of living related donor transplant is that the procedure can be scheduled electively that works best for the donor and recipient.

There is a very small risk of complications to the donor. Out of the 170 pediatric living related liver transplants performed in our programme, there have been no significant complications in the donor population.

Q- What is the average hospital stay for a donor?

Ans- Most donors are hospitalized for 7-10 days after the surgery. The incision staples are usually removed about 7-10 days postoperatively.

Q- How does donation affect the donor's ability to work?

Ans- The recovery time for this type of surgery varies, but most donors are advised that they will require up to 3 months before complete recovery of normal health and activity.

Q- How long will the operation take?

Ans- A typical liver transplant can last from 8-12 hours. The surgery for the donor lasts approximately 5-6 hours.

Q- What are the risks of transplant surgery?

Ans-There are risks with transplant surgery just as with any major surgery. Some immediate complications can include bleeding and blood clotting problems, respiratory problems and malfunction of the donor organ. Long term complications include rejection (when your child's immune system does not accept the new liver) and infection. Fortunately, most of these complications are treatable but occasionally there may be a need for a second transplant.

Q- What is the postoperative period like for the child who undergoes liver transplantation?

Ans- After your child's surgery, he/she will be taken to the transplant ICU where he/she will stay for more than a week. After your child is transferred out of the ICU to the pediatric floor, the length of stay will depend on how quickly he/she recovers. The average length of hospital stay is 3 weeks.

Q- What medications will my child take at home after transplant?

Ans- Your child will take 2 major types of medications to prevent rejection. If your child misses a dose, you need to contact our team immediately.

Q- My child leaves the hospital, what happens?

Ans- Initially your child has to come to the transplant clinic twice a week for laboratory work and physical examination or as advised by our team. As recovery progresses, these visits become less frequent.

Q- Who will look after my child in the long term?

Ans- Your child will be looked after by the primary pediatrician who will be supported by our team. Reports will be communicated to us via e-mail or fax.

Q- What restrictions will my child have during her recovery?

Ans- For the first six weeks after surgery, your child should avoid rigorous exercise.

Q- What lifestyle changes are associated with liver transplants?

Ans- Most patients can return to a normal or near-normal lifestyle six months after a successful liver transplant. Recipients should avoid exposure to people with infections. Maintaining a balanced diet, and complying to prescribed medications are vital to staying healthy. Children can attend school and participate in sports and other age-appropriate activities and can have a normal married life with no fertility issues.

Q- What is the survival rate for children with liver transplants?

Ans- Our centre performed the first successful pediatric liver transplant in India in 1998. Our survival rate is around 90%. Survival rates vary from centre to centre around the world. In our centre at Indraprastha Apollo Hospital, Delhi we have results comparable to the most well established centers across the world.