When Your Child Needs a Liver Transplant
Being informed that your child needs a liver transplant might leave you feeling frightened, upset, or puzzled. You might not fully comprehend why your child requires a new organ or where the new organ will originate from. Simply thinking about the months ahead may fill you with fear and concern.
Fortunately, many liver transplants are successful. Lots of kids who undergo these procedures go on to live normal, healthy lives once they recuperate from surgery.
In the long term, kids will need to take medications to assist prevent complications and have regular examinations to keep track of liver function.
Liver transplant is thought about when the liver stops to work sufficiently. More than half of all pediatric liver transplants are performed in children with biliary atresia. In this condition, which starts right after birth, the bile ducts fail to develop normally and are unable to drain bile from the liver.
Causes of Liver Failure
The liver– a soft, triangular-shaped organ– is the body’s biggest solid organ. It lies next to the stomach on the right side of the abdominal area. The liver has lots of jobs, like cleaning the blood of toxins, producing bile (which assists to break down food during food digestion), and keeping energy in the form of a sugar. When the liver quits working as it should, a child can get very sick, as well as die.
The liver may fail to work correctly for numerous reasons. Among children, the most typical factor for liver failure is biliary atresia. This occurs when the liver’s bile ducts (tubes that carry bile out of the liver) are missing out on or blocked. When bile can’t leave the liver, it causes liver damage, or cirrhosis. The causes of biliary atresia are unknown. Some children who have it are born with it; others establish it later on.
Other factors the liver might stop working consist of:
- alagille syndrome: an acquired (genetic) disease that causes liver irregularities and other problems
- alpha-1-antitrypsin shortage: this inherited disorder avoids the body from producing the protein alpha-1-antitrypsin, causing lung and liver damage
- hemochromatosis: an acquired disease that causes the body to take in and shop excessive iron, which can damage lots of organs
- hepatitis: this liver inflammation can have a range of causes
- Wilson disease: an inherited condition that causes an accumulation of copper in the body, which can damage lots of organs
Getting a Healthy Liver
Medical professionals just advise a liver transplant after they have exhausted all other treatments for aiming to conserve a child’s liver.
During transplant surgery, the sick liver is gotten rid of and replaced with a healthy liver (or simply part of a liver) donated from another individual. Many organ donors are adults and children who have actually concurred (or their guardians have actually concurred) to donate their organs in case of an untimely death. They decide to donate the organs since they want to assist someone else who is ill.
If a child does not require an entire brand-new liver, often a portion of a liver can be contributed from a living individual, like a parent. This is called a “living-related donor transplant.” An individual who donates part of his or her liver can have a normal-sized liver again within simply a few weeks of contributing the tissue because livers are organs that grow brand-new cells by themselves (called regeneration).
Also, a child who gets a part of a new liver will restore enough liver tissue to have a normal-sized liver within a couple of weeks of transplantation.
Determining When Surgery Is Needed
If your doctor thinks your child might gain from a liver transplant, you’ll be referred to a transplant center. There, a group of cosmetic surgeons, liver specialists (hepatologists), a transplant planner, nurses, nutritionists, psychologists, and social employees will examine your child to identify whether he or she is a good candidate for the procedure.
The assessment will include a case history, a physical examination, and some tests, including blood tests and imaging tests (such as an abdominal ultrasound or CT scan). To examine the liver more carefully, the medical professionals also may carry out a biopsy (in which a sample of the liver is eliminated to be examined under a microscopic lense).
During the assessment, the transplant group will look for out as much info about your child as possible. This is likewise a time for you and your child to find out about transplant surgery. The transplant team is there to offer info and assistance. Be sure to inquire questions if you do not understand something.
Waiting on an Organ
If the transplant group chooses that a liver transplant is the right treatment, your child will be put on an organ waiting list. This list has the names of all individuals who are waiting on organ transplants. About 15,000 Americans are on the waiting list for a liver transplant, including more than 500 children.
A group called the United Network for Organ Sharing (UNOS) manages this list and supervises of fairly identifying who receives the contributed organs. They do this based upon a rating that represents how sick someone is and how rapidly the individual needs a brand-new liver. The score for children is referred to as the pediatric end-stage liver disease, or PELD, score.
Organs are also assigned based upon which person on the waiting list is the best match for the organ donated. That means that the organ is the right size for the individual’s body and the donor has the very same blood type as the recipient.
Your child might need to wait to discover a liver that is an excellent match. Unfortunately, no one understands how long that wait will be. It might be simply a few days, or it could be years.
Waiting can be difficult. It can help to discover a support system of parents whose children have actually had transplants or are waiting on transplants. To find a group in your area, talk with your child’s doctor or the social employee at the medical facility, or check online.
Getting the Call
When a liver becomes available that is an excellent match, your household will be informed by phone or pager and you will need to go to the healthcare facility right away. Because this might occur at any time, you need to always be prepared.
When you get to the health center, the transplant team will prepare your child for surgery. They may do numerous tests to guarantee that the liver is an excellent match. Once the group decides that whatever is OKAY, your child will be moved to an operating room.
In the operating room, your child will be given anesthesia, so that he or she will sleep through the surgery and not feel anything. The medical professionals will make a cut in your child’s belly, through which they will remove the sick liver and put in the donated liver. Capillary and bile ducts from the brand-new liver will be connected to the other organs. The cut will then be sewn closed.
A lot of liver transplant surgeries take between 6 and 10 hours. Someone on the transplant group will keep you informed about how the procedure is going while you wait.
Right after the surgery, your child will be transferred to a space in the pediatric intensive care system (PICU). You must be able to be with your child at this time. Your child will be offered pain medication and may be resting when you show up.
The length of time a child stays in the PICU depends upon his or her condition. Normally, the stay is simply a couple of days. When all set, your child will be moved from the PICU to a special system in the medical facility for transplant patients. There, the transplant group will care for and closely monitor your child. Most kids don’t have any problems after the surgery, however bleeding, infection, and other issues can occur.
Most children remain in the healthcare facility for a couple of weeks after surgery. During this time, they and their families find out how to look after the brand-new liver. Make certain you understand all the doctors’ guidelines, due to the fact that your child will have to follow them carefully.
When the transplant group agrees that your child is ready, she or he will be discharged from the medical facility. In the weeks that follow, though, your child will return to the medical facility lot of times so that the medical professionals can continue to make certain that everything is working out.
One of the most common problems after transplant surgery is rejection. Rejection is the body’s regular reaction to a foreign substance. Normally, this reaction is beneficial. For example, it’s the way the body safeguards itself against harmful bacteria.
In the case of a liver transplant, the body doesn’t recognize the new liver and doesn’t understand that the liver is valuable. As an outcome, the immune system aims to attack it. Medicines (called immunosuppressants) help to manage this response. In a sense, they fool the body into accepting the new organ.
Although the risk of rejection is greatest in the first few weeks after transplant surgery, the body never ever totally accepts a brand-new liver therefore anti-rejection medications need to be taken for life. The transplant team will choose which medications are best for your child and these should be taken precisely as instructed.
Anti-rejection medications can cause some undesirable side effects, such as fever, headache, queasiness, tiredness, and irritation. Make certain to report these and other reactions to your doctor. Regrettably, these medicines also leave kids vulnerable to particular infections. This risk is greatest right after surgery, and your child will be given other medications to help reduce this risk. When possible, your child ought to prevent people who are sick to lower the risk of infection.
Usually, the quantity of immunosuppressants an individual takes is slowly reduced as the body gets used to the brand-new organ and the risk of rejection reductions. Seldom, the body refuses to accept the new organ and another liver transplant is essential.
Staying Healthy for Life
Practically all children who have liver transplants go on to live regular, healthy lives after they recuperate from the surgery. Regular checkups are had to monitor for complications. Initially, these checkups will happen typically (possibly weekly). Slowly, they’ll become less regular and eventually might be required only one or two times a year.
After transplant surgery, you can assist your child by making certain that he or she takes all medications as directed. Also, encourage your child to obtain lots of workout and eat well. These healthy behaviors will help to make sure that the brand-new liver stays healthy for life.