Types of Liver Transplants

The new organ may come from someone who has just died. This is called a “deceased donor transplant.” Or, the new liver may come from an adult who donates part of their liver. This is called a “living donor transplant.” The living donor’s remaining liver redevelops. It returns to normal size and function within a couple of months of the surgery.

Potential living donors must be in good physical and mental health. They must go through medical tests, including blood tests, to determine compatibility with the recipient.

> Learn more about living liver donation.

Before a Liver Transplant

Why Would My Child Need a Liver Transplant?

When a disease or disorder causes the liver to stop working properly, your child may need a liver transplant. The most common condition requiring children to need a liver transplant is biliary atresia. This is a rare disease of the liver and bile ducts occurring in newborns. Symptoms often appear when the child is 2 to 8 weeks old.

Other conditions that often require a liver transplant include:

• Liver cancer or tumors such as hepatoblastoma or hepatocellular carcinoma
• Acute liver failure caused by viral infection, overdose of certain medications or autoimmune disorders
• Genetic and hereditary disorders such as Alagille syndrome and Alpha-1 anti-trypsin
• Gallbladder (Cholestatic) disorders such as primary sclerosing cholangitis
• Hemochromatosis, a condition in which too much iron builds up in the blood causing organ damage

Preparing for a Liver Transplant

After your child is referred to us, they will be scheduled for an evaluation. It may take several weeks to get appointments and diagnostic tests scheduled. For urgent cases, the appointment is scheduled as soon as possible. It may be done in the pediatric intensive care unit (ICU) or on the transplant floor.

Pre-Transplant Evaluation

Your child’s first appointment begins with an in-depth exam. This includes blood work, imaging and other tests to confirm their diagnosis. Our team decides if transplant is the best option. If a new liver is needed, they will evaluate the urgency of your child’s condition.

During this visit, our liver transplant team shares our approach to pre- and post-transplant care. We help you understand your child’s illness, the transplant operation, and the risks and benefits of this surgery.

Liver Transplant Team

The Liver Transplant Center is home to specially trained clinicians with a wide range of backgrounds and areas of focus. Our diversity makes us better prepared to care for your child’s unique needs.

The liver transplant team includes:

• A transplant surgeon
• A transplant nurse coordinator
• A surgeon who specializes in treating the liver, bile duct and pancreas
• A doctor specializing in pediatric liver care, called a hepatologist
• A psychiatrist or psychologist
• A social worker
• A pharmacist
• A nutritionist
• A transplant financial counselor
• A chaplain

While Your Child Waits for an Organ

If your child is accepted for a liver transplant procedure, they will be placed on the national transplant waiting list.

People with the most urgent need for a new organ are placed higher on the list. During this time, our team will closely monitor your child’s condition. Support groups are available to help you during this overwhelming time.

> Watch a video about the evaluation process and the transplant waitlist.

Our team will contact you when a liver becomes available. You will need to get to the hospital quickly to prepare your child for surgery. If the liver is from a living donor, the surgery will be planned in advance.

> Watch a video about what to expect when it is time to come to the hospital for organ transplant.

Talking to Your Child about the Liver Transplant Procedure

Waiting and preparing for a liver transplant can be stressful and overwhelming. Your child may feel hopeful, but also a little scared.

Parents and other family members may be uncertain about how to support their child through this process. Our team will walk beside you every step of the way. We also will give your family a guide written by one of our child life specialists. The guide offers tips for helping children understand and cope with the various stages of the process. Hopefully, this information will help you feel more confident facing this challenge.

> Watch a video about how we’ll care for your child’s mental health during the transplant process.

Liver Transplant Procedure

During the liver transplant procedure, your child will be given general anesthesia for the surgery.

After they are asleep, the transplant surgeon will make an incision (cut) on the upper part of their belly. The surgical team will then remove the old liver. They will leave portions of the major blood vessels in place. Next, the new liver will be put in place.

The team will connect the new liver’s blood vessels to your child’s blood vessels. The new liver’s bile ducts will be connected to your child’s biliary system. The team will check the connections to make sure they are not leaking.

The incision is then closed using special surgical thread or staples.

Liver Transplant Communication Process

During the transplant, your family will wait in the surgery waiting area. The procedure could take from four to 12 hours. The liver transplant coordinator will give updates throughout the procedure.

After the surgery, the transplant surgeons and nurse coordinator will meet with you. They will share how the procedure went and answer any questions. During this time, your child will be taken to the pediatric intensive care unit (PICU). The nurses and doctors will make sure your child is comfortable and safe. You’ll be able to visit after about one and half hours.

After a Liver Transplant Procedure

After the transplant procedure, the transplant team will monitor your child in the PICU. Once your child is stable, we will move them to a different floor in the hospital. They will be cared for by a nursing staff focused on liver transplant patients. You will see the members of the liver transplant team daily. They will keep you informed about your child’s progress and make suggestions for their care.

The length of the recovery process varies from patient to patient. It depends partly on the child’s health before the transplant.

Nutrition and Diet After a Liver Transplant

Good nutrition is important for healing. A day or two after the transplant, we will give your child a liquid food mixture through an intravenous catheter (IV). When normal bowel function returns, we will start your child on a clear liquid diet. Once that is tolerated, they can move to solid foods.

Infants put on special formula before a transplant usually can be returned to regular formula. The transplant team may supplement your child’s diet with a feeding tube for some time. This will boost calorie intake to support recovery.

Liver Transplant Care at Home

Our liver transplant coordinator will teach you how to care for your child at home. We’ll review your child’s medications. We will also show you how to care for the incision sites, central line (a long-term IV), external drains and feeding tube. You will receive this information in writing as well.

Giving medicines as directed and on time is an important part of caring for your child at home. Help your child learn to manage their own care as they get older.

> Watch a video to learn more about medication adherence.

Long-term follow-up care is very important to keeping your child’s new liver healthy for years to come. We partner with families and their local doctors (primary care or gastroenterology) to provide care into adulthood.

What are Potential Complications of a Liver Transplant?

A liver transplant can save a child’s life. But even when the surgery goes well, problems can occur. These may result in hospital readmission, a liver biopsy or other specialized testing.

Some possible complications are:

• Liver rejection
• Learn more about rejection and how it is managed at Cincinnati Children’s to protect the transplanted liver
• Watch a video to learn more about liver biopsy and how it is used to diagnosis liver rejection.
• Kidney problems
• Bile duct problems
• Primary nonfunction (when the new liver does not "wake up" after surgery)
• Thrombosis, or blood clot
• Bleeding

When to Call Your Child's Doctor

Call your child’s liver transplant coordinator or primary care doctor right away if you notice these symptoms:

• Temperature greater than 100.5° Fahrenheit (38° Celsius) under the arm or by mouth
• Blood pressure greater than the recommended level on two consecutive measurements
• Shortness of breath
• Active chickenpox lesions or shingles
• Unusual irritability with sleepiness
• Seizure activity
• Any urgent changes in your child's condition
• Redness, swelling, or drainage from incision site, central line site, or PICC site
• Vomited again after the second attempt at keeping down their antirejection medication

Call the liver transplant coordinator during normal business hours about any of the following symptoms and procedures within 24 hours:

• Continued fever over than 100° Fahrenheit (37.7° Celsius) under the arm or by mouth
• Loose stools (diarrhea) for longer than 24 hours
• Dental visit or any dental procedure
• Exposure to chickenpox or shingles
• Vomiting more than three times in 24 hours. Always call if your child is unable to keep immunosuppressive medications down.
• Not able to take other medications and keep them down (not antirejection).
• Belly pain or swelling
• Light-colored or bloody stools (poop)
• Bloody or foul-smelling (smelly) urine (pee)
• Painful urination
• Yellow-colored eyes or skin (jaundice)
• Rash

Prescriptions

The liver transplant coordinator renews prescriptions Monday through Friday, 8 am to 4:30 pm. Please keep track of your medication supply and call the liver transplant office during these hours when a prescription refill is needed.

For emergency prescription needs after these hours, the on-call liver transplant doctor calls in only the required amount of medicine needed until the next business day. Your child's primary coordinator will call in the rest of the prescription after reviewing your child's chart the next business day.

Please make sure to call if you are having trouble getting medicines at your pharmacy.

Pediatric Liver Transplant: Contact Us

The team at the Pediatric Liver Care Center at Cincinnati Children’s welcomes your questions. Contact us at 513-803-1664 or 1-800-344-2462, ext. 6-4955, and ask to speak to a liver nurse specialist.

Referrals and the Physician Priority Link^®

Physician Priority Link at Cincinnati Children’s provides immediate, 24-hour access to liver care specialists. For emergency transfers or urgent inpatient / outpatient referrals, call 513-636-7997 or 1-888-636-7997. Ask for the Pediatric Liver Care Center attending physician.

This service also may be used to reach a liver care specialist for consultation about non-referral cases.