Which conditions make transplantation necessary for my child?
Globally, most pediatric liver transplants are performed on children with biliary atresia (absence of bile ducts). In addition, various diseases that cause acute hepatic failure such as viral hepatitis, metabolic diseases (Wilson’s disease, Galactosemia, thyrosinemia, urea cycle defects), drug or toxin induced autoimmune hepatitis, cholestatic diseases that cause chronic hepatic failure, hepatitis, cancers (HCC, Hepatoblastoma), vascular problems (Budd- Chiary Syndrome, Veno-occlusive Disease) and cryptogenic cirrhosis are treated with liver transplant.
How are evaluations done?
As is the case with any patient, evaluation of a patient presenting for liver transplant starts with medical history and physical examination. Later, it is continued with blood tests, radiology studies and relevant consultations. Tumor and infection markers are also screened, as immunosuppressive agents used after transplant surgery have the potential to worsen an existing cancer or infection.
How does transplant process performed?
As is the case with any patient, evaluation of a patient presenting for liver transplant starts with medical history and physical examination. Later, it is continued with blood tests, radiology studies and relevant consultations.
Tumor and infection markers are also screened, as immunosuppressive agents used after transplant surgery have the potential to worsen an existing cancer or infection.
How does transplant process performed?
There are two types of liver transplant surgery; deceased (cadaver) donor or living donor. For deceased donor transplants, a donor with a healthy liver, who is diagnosed with brain death, is needed and the operation is performed following preparations that are carried out under emergency circumstances.
On the other hand, for living donor transplants, both the donor and the recipient have detailed examinations and tests to minimize postoperative complications. Living donor liver transplant surgery uses left lobe of the donor liver.
In the recipient surgery, the diseased liver is completely removed and the liver of deceased or living donor with appropriate volume is placed.
How will daily life of my child be affected after transplant surgery?
First of all, the patient holds on to the life again after a successful liver transplant surgery. Outpatient follow-up visits are planned at weekly intervals for the first month after the patient is discharged, and next, these intervals are prolonged thereafter. Skin sutures are removed three weeks after the operation. Children can continue school life within 2 months on average.
Deceased Donor
What does deceased donor liver transplant mean?
The liver of deceased donor with medically declared brain death is surgically removed, after consent of the family is obtained for deceased organ donation, and it is supplied to most appropriate patient, who is registered in organ waiting list, according to the rules supervised by Ministry of Health. Candidate recipient is urgently called and prepared for surgery under emergency circumstances and the deceased donor liver is transferred to the recipient as soon as possible.
How is deceased donor transplant surgery performed?
If a liver transplant candidate with no living donor scores ≥15 in PELD scoring test – a scale specific for children- in the light of the blood tests and the disease that leads to liver failure, the candidate is registered in the deceased donor transplant list. When a match deceased donor is found and presented to our Organ Transplantation Center over the system of Ministry of Health, surgical removal of the deceased donor liver is started. Relevant team goes to the hospital, wherein the deceased donor is present, and the liver and other appropriate organs are removed and placed in cold storage containers. Meanwhile, candidate recipients, who are registered in our center, are listed again over the system of Ministry of Health. Candidate recipients are called, starting with the first patient in the list. Second candidate is contacted if the first one declares inability to present for surgery. The patient who declares to present for surgery is admitted, preoperative examinations and investigations are urgently completed and the patient is undergone surgery, if no contraindication is detected.
Can an appropriate liver of an adult deceased donor be transplanted to my child?
The liver broadly consists of a relatively larger right lobe and a small left lobe. When a liver is transplanted to pediatric patients, the left lobe is usually preferred since the entire liver or the right lobe will not fit. The deceased donor liver is divided into right and left lobes under appropriate conditions and the left lobe, which is more suitable for the child, is transplanted. Remaining right lobe of the liver can be used for another adult candidate recipient.
How is care of my child maintained in waiting period?
Patients, who are registered in the deceased donor transplant list, should visit our Organ Transplantation Center for relevant follow-up examinations at regular intervals. This allows them to be as much prepared as possible in case a deceased donor is found for liver transplant surgery in an unexpected time. Unfortunately, it is not possible to estimate this interval. Relevant medication treatments and medical examinations should be maintained at pediatric gastroenterology outpatient clinic in the waiting period.
What will happen when my child is admitted for organ transplant?
The patient who gives positive response to our call should present to our Organ Transplant Center as soon as possible. Patients should not eat or drink (at least for 6 hours) before the surgery since they will be operated on. Various consultations and examinations are performed for the patient depending on the date of last follow-up visit. Family of the patient with no contraindication for surgery is informed and the patient is transferred to the operating theater after their consent is obtained.
Living Donor
Who can be a donor for my child?
It is necessary to be older than 18 and cognitive functions should be intact according to the legislation in our country. Moreover, consent of the donor and the spouse, if any, is obtained for kinships up to 4th degree, but approval of Ethics committee is required for kinship beyond 4th degree.
1st degree relative: Father and mother.
2nd degree relative: Sibling, grandmothers and grandfathers
3rd degree relative: Maternal uncle, paternal uncle, maternal aunt, paternal aunt, niece
4th degree relative: Children of maternal uncle, paternal uncle, maternal aunt, paternal aunt and niece
What are advantages of living donor transplant for my child?
It is possible to minimize perioperative complications for recipient candidates of the liver transplant, as detailed tests, examinations and preparations are carried out in elective (non-emergent) circumstances.
Moreover, it is required to store liver of cadaver donor in a cold storage container for many hours until it is transferred to the recipient, while this interval can be decreased to minutes in living donor transplants and thus, complications of this necessity can be prevented.
What should donor of my child expect in transplant surgery?
The volunteer living organ donor is evaluated in detail to determine whether s/he is appropriate for liver donor surgery. All organ systems are reviewed and relevant blood tests, radiology studies and consultations are performed to determine whether the donor has a known disease or not. If a contraindication for surgery is detected in detailed examinations, the process is stopped and the donor is refused.
A candidate donor with favorable test results is informed about risks of surgery and the consent is obtained before two witnesses.
Date of operation is scheduled and the donor is hospitalized in organ transplantation unit one day before the operation and relevant preparations are initiated. In the surgery, right lobe of the liver is removed if the recipient is an adult or the left lobe is removed if the recipient is a child. The patient is transferred to the intensive care unit after the surgery, and after the patient is stabilized here for 1 to 2 days in average, they are transferred to the room in organ transplantation clinic.
If all parameters are stable in inpatient follow-up, donors are discharged in 5 to 7 days in average. Patient is asked to present for outpatient follow-up visits after the discharge and skin stitches are removed 10 days after the operation. They can start driving one month later and resume activities of daily life and work in 2 months in average.
The space that forms after the liver is removed is covered in approximately 1 month by the rest of liver that grows gradually.