In the medical world, organ transplants are sometimes needed to treat certain diseases. One of the organs frequently transplanted is the liver. Not only adults, but children can also undergo this procedure when necessary.
So, how is a liver transplant performed in children? What conditions require a child to undergo this procedure?
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What is a Liver Transplant in Children?
A liver transplant is a surgical procedure to replace a diseased liver with a healthy one from another person (a donor). The donated liver can come from a deceased donor or from a living, healthy person (a living donor).
A living donor may be a family member or someone unrelated who has a compatible blood type.
For your information, a person who donates a portion of their liver can still live healthily with the remaining liver. This is because the liver is the only organ in the body that can regenerate lost or damaged tissue.
The donor’s liver will regrow to normal size after the surgery. Meanwhile, the portion of liver received by the child will also grow to normal size within a few weeks.
Purpose of Liver Transplants in Children
Liver transplants are recommended for children with severe liver problems who cannot survive without a new liver.
The most common liver disease in children requiring a transplant is biliary atresia, a rare liver and bile duct disease that occurs in newborns.
Other conditions that may require a liver transplant include:
- Liver cancer or liver tumors
- Acute or sudden liver failure due to autoimmune disease, unknown causes, or drug overdose (such as acetaminophen)
- Genetic or hereditary liver diseases
- Congenital conditions like Alagille syndrome or cholestatic disorders
- Viral hepatitis
- Excess iron buildup in the body that can damage organs (hemochromatosis)
- Alpha-1 antitrypsin deficiency (a genetic condition increasing the risk of liver disease)
Preparation for a Liver Transplant in Children
If a child needs a liver transplant, the doctor will refer them to a transplant center. There, the child and their parents will meet with the transplant team, which usually includes:
- A transplant surgeon
- A liver specialist (hepatologist)
- A transplant coordinator
- A pharmacist
- A nutritionist
- A psychologist
- A social worker
- A child life specialist
The doctors will need to ensure the child is healthy enough to undergo the transplant and can take the required medications afterward. The medical team will also run tests, including:
- Blood tests
- Imaging tests (such as abdominal ultrasound or CT scan)
- Biopsy — taking a small tissue sample from the liver to examine under a microscope
If the transplant team determines that the child is a suitable candidate, the next step is to find a donor. The child’s name will be added to an organ waiting list, which includes all people waiting for liver or other organ transplants.
The family may also discuss the possibility of a living donor. The transplant team will guide the parents in finding a suitable living donor for the child.
While waiting for a suitable liver, parents are advised to keep the child as healthy as possible to ensure they’re ready for the transplant when the time comes. This includes:
- Providing healthy meals
- Giving medication as directed by the doctor
- Attending all scheduled doctor visits
The Liver Transplant Procedure in Children
Once a liver becomes available, the doctor will ask the child and parents to immediately go to the hospital. This call can come at any time, so parents must always be prepared.
At the hospital, the child will undergo tests to confirm the donor liver is compatible. Then, the liver transplant surgery will begin.
This operation may take several hours depending on the child’s liver condition. During the surgery, a transplant team member will update the parents on the progress.
Here are the general steps of a pediatric liver transplant:
- The child will change into special surgical clothing.
- An IV will be inserted into the arm or hand. Other tubes or catheters may be inserted into the neck, wrist, under the collarbone, or groin to monitor heart rate, blood pressure, and to take blood samples.
- The child will lie on their back on the operating table.
- A catheter will be inserted into the bladder to drain urine.
- General anesthesia will be administered to put the child to sleep. A breathing tube will be placed to assist with ventilation during surgery.
- The anesthesiologist will continuously monitor heart rate, blood pressure, breathing, and oxygen levels.
- The skin over the surgical area will be sterilized. The surgeon will make an incision below the ribs on both sides of the abdomen, extending vertically above the breastbone.
- The diseased liver will be carefully separated from nearby organs and structures.
- The arteries and veins connected to the liver will be clamped to stop blood flow.
- The diseased liver will be removed, and the new donor liver will be attached to the child’s blood vessels.
- The new liver will then be connected to the bile ducts.
- The incision will be closed with stitches or surgical staples.
- Drainage tubes will be placed to reduce swelling, followed by sterile dressings or bandages.
After the Liver Transplant Procedure
After the surgery, the child will be moved to the intensive care unit (ICU) for close monitoring. The length of stay in the ICU depends on the child’s condition.
Once stable, the child will be transferred to a specialized hospital ward for liver transplant patients, where they will continue to be closely observed.
The doctors will inform the parents about medications, physical activities, follow-up appointments, diet, and other important instructions.
Pediatric Liver Transplant Specialist at RS Mandaya Royal Puri
RS Mandaya Royal Puri has a renowned pediatric surgeon capable of performing liver transplants: Dr. Sastiono, Sp.B, Sp.BA. He is one of the few doctors actively involved in liver transplant procedures in Indonesia.
In addition to pediatric liver transplants, Dr. Sastiono also performs other surgeries such as:
- Hernia surgery in children
- Appendectomy (appendix removal) in children
- Treatment of biliary atresia (blocked bile ducts)
- Treatment of anal atresia (abnormal anus)
- Treatment of intestinal blockages in children
- Treatment of liver abnormalities in children
Dr. Sastiono, commonly known as Dr. Sas, is a member of the Indonesian Medical Association (IDI) and the Indonesian Surgeons Association.
Clinic Hours at RS Mandaya Royal Puri:
- Tuesday: 10:00 AM – 1:00 PM
- Thursday: 10:00 AM – 1:00 PM
If you wish to consult about liver transplants in children or general child health, don’t hesitate to visit RS Mandaya Royal Puri.
To make your visit easier, use the chat feature via WhatsApp, the Book Appointment service, or the Care Dokter app, which is available on Google Play and the App Store to check queue numbers and get complete information.