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Pediatric Liver Transplantation in India

Pediatric Liver Transplantation in India

July 25, 2020

Introduction

Liver transplant surgery, in children, is most commonly due to biliary atresia. Other conditions also require a liver transplant. Before surgery, a comprehensive health evaluation of the children is done.


Conditions Requiring Pediatric Liver Transplant

Liver transplant surgery is the last option in the case of liver diseases. It is advised when other treatment fails to revive the liver functions. The most common disease requiring pediatric liver transplant is biliary atresia. It is the condition in infants characterized by blocking and scarring of the biliary duct. It results in liver damage. The other disease that results in liver transplantation includes:

  • Liver cancer and liver tumor
  • Wilson disease
  • Tyrosinemia
  • Alpha 1-antitrypsin deficiency
  • Sudden or acute liver failure due to medication toxicity or any other medical condition
  • Familial hypercholesterolemia
  • Alagille syndrome or cholestatic disorders
  • Hemochromatosis


Evaluation For Liver Transplant Requirement

During this evaluation, the hepatologists will determine the severity of the liver disease. Based on the severity, the doctor will decide if the child requires liver transplant surgery, and within how much period the surgery should be done. During the evaluation phase, the queries of the patients regarding the diseases and the need for liver transplant is discussed.


Pre-Surgery Evaluation

Once it has been decided that the liver transplant is the best option to save the life of the child, the doctor will conduct a detailed evaluation to determine if the child is fit for the surgery. Following are some of the examinations performed:

Blood tests: The blood test of the child is done to determine the presence of any disease. The blood tests also help in finding the best match for the patient for donating the liver.
Diagnostic tests: The diagnostic test should be done through various techniques such as ultrasound, X-rays, and liver biopsy. These tests are done to determine the overall health of the patient.
Psychological evaluation: Psychological evaluation is done to determine if the child is mentally fit to take the stress of surgery. This is usually done on the older child. 

Unfortunately, children with metastatic liver cancer, heart problems, chronic infection, and serious conditions other than liver disease are not suitable candidates for liver transplant surgery.


Waiting For Liver Transplant Surgery

If your child is deemed fit for a liver transplant, his name is listed on the waiting list. The priority on the list is given according to the PELD score (MELD for adults). The child may be on the waiting list unless the suitable donor is not found. During the waiting period, the child is under constant monitoring of the liver transplant surgeon.


Transplant Surgery

The child will be called immediately for surgery in case a suitable cadaveric donor is found, or the child would be admitted a day before surgery in case of a live donor. It is natural for the parents to go through the emotions as they have anxiety for their child. However, it is to be noted that the success rate of pediatric liver transplantation in India has been significantly increased because of advanced technology.


Recovery Period

During the recovery period, the child has been prescribed various medications. These include immunosuppressant medications, anti-infective medications, and analgesics. As the body recovers, many of these medicines are either stopped, continued at the low dosage or reduced frequency.


Post-Liver Transplant Surgery

After the liver transplant surgery, the child should be under constant monitoring of the transplant team. The parents should take the child to the hospital as a schedule to determine the progress of surgery.