What is a Pediatric Liver Transplant?

A pediatric liver transplant is a surgical procedure that replaces a child’s damaged or failing liver with a healthy liver from a donor. During the operation, surgeons remove the diseased liver and implant a healthy donor liver to restore normal liver function.  

The liver is the body’s second-largest organ and plays an essential role in filtering toxins, producing proteins and helping the body digest nutrients. When a child’s liver can no longer perform these vital functions, a transplant may be the most effective treatment option to help restore health and support normal growth and development.

How is a pediatric liver transplant performed?  

During the procedure, specialized transplant surgeons remove the diseased liver and implant a healthy donor liver. Pediatric liver transplants can be accomplished a number of different ways depending on your child's needs:  

• Whole liver transplant: The surgeon transplants a whole donor liver to the patient.
• Split liver transplant: A donated liver gets divided into two parts. The smaller part gets used for the pediatric patient, and the larger section may be transplanted into an adult.
• Living donors: Part of the donor’s liver is removed and transplanted to a child. The liver section remaining in the donor, along with the pediatric recipient’s liver, both grow to proper size over time.
• Deceased donors: The liver is removed for transplant following the donor’s death. 

What are the criteria for a child to qualify for a liver transplant?

Children may be considered for a liver transplant when their liver disease is severe and cannot be effectively treated with medication or other therapies. Pediatric liver transplant teams evaluate several medical and surgical factors to determine whether a child is a good candidate for transplantation at that time.

1. Severity of liver disease: A transplant may be recommended for children with advanced chronic liver disease, acute liver failure, certain metabolic disorders or liver tumors that significantly impair liver function.
2. Pediatric End-Stage Liver Disease (PELD) score: Doctors use this scoring system to measure how severe a child’s liver disease is and how urgently they need a transplant. The score is calculated using lab results and factors such as bilirubin levels, blood clotting ability, albumin levels, kidney function and growth.
3. Overall health and transplant readiness: The transplant team evaluates the child’s overall medical condition to ensure they are healthy enough to undergo surgery and recover after the transplant. 

What are the risks and complications of pediatric liver transplant?

Like any major surgery, pediatric liver transplants carry certain risks. While results for children have improved significantly over the past few decades, transplant teams carefully monitor patients for potential complications both immediately after surgery and in the years that follow.

• Organ rejection: The child’s immune system may recognize the new liver as foreign and try to attack it. Anti-rejection medications are required long term to help prevent this.
• Infection: Because transplant recipients take immunosuppressive medications to prevent rejection, they may have a higher risk of infections.
• Surgical complications: Problems with blood vessels or bile ducts can occur after transplant and may require additional treatment or procedures.
• Medication side effects: Long-term immunosuppressive medications can lead to complications such as kidney problems, high blood pressure, or metabolic changes.
• Long-term health concerns: Some children may experience growth, metabolic or quality-of-life challenges over time, which is why ongoing follow-up with a transplant team is essential. 

How long does a pediatric liver transplant surgery take?

A pediatric liver transplant is a complex surgery that typically takes six to 12 hours to complete. During the procedure, surgeons remove the diseased liver and carefully connect a healthy donor liver to the child’s blood vessels and bile ducts so it can begin functioning normally.

What are the causes of liver disease leading to liver transplant?  

Children may need a liver transplant when severe liver disease damages the liver to the point that it can no longer function properly and other treatments are no longer effective. Several conditions can lead to this level of liver failure.

Biliary atresia: The most common cause of pediatric liver transplantation. This condition occurs when bile ducts are blocked or absent, causing bile to build up in the liver and leading to progressive damage.

Genetic and metabolic liver diseases: Conditions such as alpha-1 antitrypsin deficiency, Wilson disease and other inherited disorders can interfere with how the liver processes proteins, metals or toxins.

Acute liver failure: Sudden liver failure caused by infections, autoimmune disease, medication toxicity or other severe illness may require urgent transplantation.

Liver tumors or other rare liver conditions: In some cases, certain liver cancers or severe structural liver diseases may make transplant the most effective treatment option. 

If your child has advanced liver disease, talking with a pediatric transplant specialist can help you understand the next steps and available treatment options.