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A pediatric liver transplant is a major, complex surgical procedure. Although the liver care team at Cincinnati Children’s is very experienced at managing the risks of transplant surgery, there are complications that can occur after the procedure. Some are not severe, while others may require follow-up treatment.
Because your child has a transplanted liver, the body recognizes the liver is not its own. The body naturally wants to get rid of, or reject, the new liver. The transplant physicians will prescribe medications to help prevent a rejection. However, approximately 50 percent of patients experience some level of rejection in the first year following transplant.
Your child’s physician will watch for liver rejection by measuring liver enzyme levels in routine blood work; elevated levels are often the only symptom of rejection. If your child’s physician suspects rejection, the liver care team will conduct a liver biopsy. If the doctor determines that the body is rejecting the new liver, your child's medications will need to be adjusted.
In most cases, treatment of rejection requires that your child be hospitalized for five to seven days. The doctor may repeat the liver biopsy to ensure that the rejection has been controlled. Usually, medications control rejection. In rare cases of severe and untreatable rejection, doctors may need to perform a new transplant.
Some children have problems related to the bile duct, which allows bile to move in and out of the liver. In some cases, patients need to have drains placed and tests performed to make sure the bile ducts are working properly.
When the liver is removed from the donor, it is placed in ice. Despite the care and precautions we take before the transplant, there are times when the new liver does not "wake-up" after surgery. This is called primary nonfunction. If this occurs, your child will need to be re-transplanted immediately.
At times, the hepatic artery or the portal vein (the vessels that supply blood to the liver), clot (thrombose) immediately after surgery. An ultrasound is performed daily for five days after surgery. If the doctor detects a clot, the team will surgically remove it. If the clot is detected quickly, it usually can be removed from the artery or vein. If the clot cannot be removed, doctors may need to perform a re-transplant.
Bleeding is a common complication in any operation, especially liver transplantation. Doctors may need to perform an additional operation to control heavy bleeding.
Learn more about the special medications available to help your child’s body accept a transplanted liver.
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