Pediatric Liver Transplant FAQ for Patients

Why is pediatric liver transplantation performed?

The surgery is required when the liver is so badly and irreversibly damaged that a transplant offers the only chance for your child’s long-term survival.

What kind of evaluation is needed to determine whether my child is a candidate for transplantation?

Before final selection and listing for liver transplantation, your child will undergo a multidisciplinary pretransplant evaluation to determine the current status of the liver disease and the extent of its progression. We want to make sure that a liver transplant is the best and safe option for your child. All outside medical records, laboratory and radiological studies, and liver biopsy materials are reviewed. Consultations are done by the transplant liver doctor and surgeon, along with a child development specialist and social worker. A pretransplant education class is conducted by the transplant coordinator, and the family meets with our hospital-based parent mentors.

After these assessments and tests are completed, our team of experts meets with the family and discusses all treatment options. If your child proves to be a candidate for liver transplantation, his or her name is added to the national liver transplant waiting list maintained by the United Network for Organ Sharing (UNOS).

UNOS is a private nonprofit organization that works under contract to the U.S. Department of Health and Human Services to promote organ donation and transplantation. UNOS coordinates the matching and placement of donor organs. UNOS also collects, validates, and maintains data on all organ donors and solid organ transplant recipients.

What happens after being placed on the UNOS transplant waiting list?

• We continue to take care of your child, in conjunction with your primary care doctors, to make sure that we keep your child as healthy as possible until the surgery.
• Together, we determine if your child’s clinical condition has changed, and if so, we adjust the status on the waiting list.

Where do donor livers come from?

There are two sources: living donors and recently deceased donors. Deceased donors are individuals whose organs have been made available for donation at their own request before death or by their families after death.

How are livers from deceased donors allocated to the children who need them?

A national waiting list is maintained by the Organ Procurement and Transplantation Network (OPTN). Basically, the sicker the child, the higher he or she is placed on the list. The exact policies are detailed on the OPTN website.

What is the postoperative period like for a child who receives a transplanted liver?

The length of hospitalization will vary, depending on the individual patient. A typical hospital stay for school-age children is seven to 10 days. Infants are usually hospitalized for two to three weeks following the transplant procedure.

Patients are placed on immunosuppressive drugs to prevent rejection of the transplanted liver. The doctors may perform a liver biopsy to check for signs of rejection. Rejection may be managed by increasing or adding immunosuppressive drugs. Since patients on immunosuppression are vulnerable to bacterial and viral infection, patients are monitored for signs and symptoms of infection.

The transplant team also monitors your child for signs of bleeding and other potential postoperative complications. Rarely, a patient will have to return to the operating room for evaluation and treatment of a postoperative complication.

Once my child leaves the hospital, what happens?

Physicians and transplant coordinators from the pediatric liver transplant program and your child’s local pediatrician monitor him or her after discharge from the hospital. Initially, your child visits the Pediatric liver transplant clinic twice a week for laboratory work and physician examinations. As recovery progresses, these visits become less frequent. Our team will continue to be a part of follow-up care even after your child is able to return home. To make it easier for families, the pediatric liver transplant program runs outreach clinics throughout the year in Hawaii, Portland, Seattle, Sacramento, Fresno, and Oakland.