Liver Transplant Center

A liver transplant is the only hope for patients with advanced liver disease and for those with acute liver failure. Unlike kidneys, which can be supported with dialysis, there are no options for treating a failing liver.

A liver transplant is recommended for children who have serious liver dysfunction, such as biliary atresia. They will not live without having the liver replaced.

The number of children awaiting liver transplant is constantly changing. The United Network for Organ Sharing (UNOS) provides up-to-the-minute data on transplant waiting list activity and transplantation statistics. UNOS data are based on numbers reported by the Organ Procurement and Transplantation Network, which maintains the only national patient waiting list. These networks are the best source of information on the number of candidates on the waiting list.

Most livers that are transplanted come from organ donors shortly after they die. Organ donors are usually adults or children who have become critically ill (often due to an accident). If the donor is an adult, he or she may have agreed to be an organ donor.  Parents or spouses can also agree to donate a relative's organs. When an organ is received from a deceased donor, it is called a “deceased donor” transplant.

A child receiving a transplant may get either a whole liver or a piece (segment) of a liver. If an adult liver is available and is a good match for two children on the waiting list, it can be divided into two segments, with each segment transplanted into a waiting child. This strategy helps transplant surgeons optimize the availability of donor livers and minimize transplant patients’ waiting times.

A living family member may also donate a segment of his or her liver that is the right size for the recipient. This type of transplant is called a “living-related” donor transplant. Children who receive segments seem to do as well as those who receive whole livers. Living-related donors can live healthy lives with the segment of liver that remains.

The United Network for Organ Sharing (UNOS) is responsible for transplant organ distribution in the United States. UNOS oversees the assignment of all solid organ transplants, including liver, kidney, pancreas, intestine, heart and lung.

UNOS receives information from hospitals and medical centers throughout the country about adults and children who need organ transplants. The liver transplant team at Cincinnati Children's is responsible for sending information to UNOS and updating this information as your child's condition changes.

Standards, or criteria, have been developed by UNOS to ensure the waiting list is fair and accurate. UNOS evaluates factors such as patient size, the severity of the patient’s condition and size and blood-type match of donor livers.

Once UNOS receives the data from hospitals, people waiting for a transplant are placed on a waiting list and given a “status” code. The people in most urgent need of a transplant are placed highest on the list and are given first priority when a donor liver becomes available.

The system used to prioritize patients waiting for liver transplants is based on statistical formulas that are used to predict which patients are most likely to die soon without a liver transplant.

UNOS uses the Model for End-Stage Liver Disease (MELD) score for adolescent and adult patients and the Pediatric End-Stage Liver Disease (PELD) score for children.

A patient's score may go up or down over time depending on the status of his or her liver disease. That is why it is important for all patients to have their MELD or PELD score reassessed on a regular basis while on the waiting list.

Getting a liver that is right for your child is one of the most unpredictable steps of the transplant process. We can’t predict when a good match will become available, but our team works closely with UNOS to make sure that when a liver becomes available it’s the right size and blood type for your child, and is healthy and ready to be transplanted.

Sometimes children have only to wait a few days or weeks for a donation. If a family member is able to donate part of his or her liver, that will accelerate the process. If a living donor is not available, though, the wait could take months or years. Much of the wait depends on your child’s condition, and the liver transplant team will monitor your child during the wait to ensure UNOS has an accurate picture of his or her need for a transplant.

Living-related donor liver transplantation, in which a family member gives part of his or her liver to the child, is an option for some families. This can save precious time, since the child does not have to be placed on a waiting list.

But not all relatives are good matches for every child. Our team members evaluate potential donors based on blood type, size and a number of donor health issues. In emergency cases, these tests can be done quickly.

The transplant operation for the adult donor takes place at Cincinnati Children's in the operating room next door to the transplant operating room.  The donor recovers in the same intensive care unit and step-down unit as the recipient, and usually is hospitalized five to seven days, depending on his or her post-operative recovery.

After going home, the donor usually has restrictions regarding work and activity for six weeks.

Children receiving liver transplants at the Liver Care Center at Cincinnati Children's may suffer from a number of conditions. The conditions that most often require liver transplant are:

• Cholestatic disorders such as Alagille syndrome, biliary atresia, idiopathic cholestasis or TPN associated liver disease
• Metabolic disorders such as citrullinemia, glycogen storage disease, hemochromatosis, OTC deficiency or tyrosinemia
• Acute liver failure from viral infection, drug toxicity or autoimmune disorders
• Cirrhosis from autoimmune or neonatal hepatitis, or cryptogenic cirrhosis
• Tumors such as hepatoblastoma or hepatocellular carcinoma 
• Other disorders such as Budd-Chiari syndrome, Abernathy's syndrome and other diseases that don't fall into other categories