When the liver fails, liver transplantation can provide hope for the child with severe liver disease. Liver transplantation has become very successful in both adults and in small babies.
Reasons for Liver Transplantation
A child may need to be transplanted for a number of reasons. Typically, children are listed for transplantation when they have liver failure or when liver failure will occur soon. Sometimes children are listed because of the complications of chronic liver disease, even without liver failure. Occasionally, children are listed for liver transplant when they have metabolic diseases where the liver works well but causes a life-threatening biochemical problem. Adults are sometimes transplanted for liver cancer as well.
Procedures for Liver Transplantation
When the gastroenterologist/hepatologist determines that the child is a transplant candidate, extensive discussions are held with the family. The listing procedure, transplant procedure, risk and benefits are explained, and if all parties agree, a transplant evaluation is initiated. Transplant evaluation begins with a number of blood tests that assess liver function, exclude other causes of liver disease, and evaluate for certain viruses that might complicate liver transplant. A thorough history and physical exam is done by a transplant hepatologist. Ultrasound is done to evaluate the liver and the vessels leading from it. An echocardiogram and chest x-ray are done to evaluate the heart and lungs. Further studies may be ordered depending on the child's other medical problems. A transplant surgeon evaluates the child and meets with the family. The transplant coordinator explains the process and provides information. The coordinator is the point contact person with the family after transplantation. The team social worker and dietitian also meet with the family during the evaluation process. The transplant hepatologist puts together all this information and presents the case to the Transplant Committee. If this group approves, the child is placed on the Liver Transplant List.
The Liver Transplant List contains name, weight and blood type for all the patients who need a liver transplant in that region of the country. The patient's size is important as the size of the new liver is matched to the child's size. The present system uses a scoring system called PELD which is calculated from a number of factors which show liver function. A higher PELD score suggests worse liver function and gives the patient a higher priority. This system depends on how sick the patient is much more than on how long the patient has waited for a transplant. When a potential donor becomes brain-dead the local and national organizations for organ sharing are informed. The computer then prints up a list of the patients who are the most sick and who match the blood type and size of the donor. The person on the top of the list, if he remains a good candidate, is called in for the transplant.
Liver Transplant Surgery
The transplant surgery is a long one since the old liver must be removed and the new liver must be sewn in, requiring connecting at least three blood vessels and a bile duct. The hospitalization after transplant has many ups and downs since the patient's immune system may try to reject the liver, recognizing it as foreign. Repeat surgery may be needed for bleeding or bile duct problems. Infection is also common. Problems with blood pressure, kidney function, etc can occur. In the long run, however, patients do well and have an excellent quality of life. Transplant patients remain on medications life-long and have frequent doctor visits and occasional procedures. Liver transplant cannot be regarded as a cure, but instead is a very good treatment for liver failure.
For More Information
Please visit the Indiana University Health Liver Transplant website.