Liver Transplant

As the largest organ in the body, the liver performs many vital functions, including processing proteins, fats and carbohydrates and breaking down toxins. It also helps the blood clot when an injury occurs. If the liver fails, the body loses its ability to clot and to process nutrients necessary for life.

The liver also produces a yellow digestive juice called bile. If the liver is not functioning appropriately, the extra bile may cause the eyes to look yellow or “jaundiced" and the skin may itch and even look yellow. Medications are available that help treat the symptoms of liver failure, but there are no medications that cure liver failure.

Most of our liver transplant patients are referred to the program by primary care doctors or by a specialist. When a referral is made to our program, a transplant assistant will call you to schedule an appointment.

A preliminary evaluation is the first step in helping you and the transplant team determine whether moving forward with an organ transplant is an appropriate treatment for your child. The transplant team will evaluate the medical factors related to your child's liver failure. Not everyone who is evaluated for a liver transplant is an appropriate candidate. Your initial appointment with our experienced transplant team will help determine your child's best treatment options.

Your child’s transplant evaluation may include:

• Blood tests to help determine how well your child's liver is functioning and to assess kidney function.
• Chest X-ray to help detect infection in your child's lungs and assess the status of your child's bones.
• Electrocardiogram to assess the healthiness of your child's heart
• Pulmonary function test measures lung capacity by having your child breathe into a machine. Blood will also be drawn to see how well oxygen is being absorbed by the body.
• Ultrasound to look at the blood flow to and from your child's liver and to locate any abnormal masses in the liver.

Your child will see the following: 

• A liver specialist (hepatologist) who will do a full exam,including a biopsy to help make a diagnosis and to assess the disease severity. They will also review your child's health history and discuss options that may include transplant.
• Transplant surgeon
• Transplant pharmacist
• Social worker
• Dietitian
• Financial counselor to review your insurance information
• Any other applicable medical specialists
• Consults: Your child may also need to see a heart, kidney, genetics, and infectious disease specialists. 
• Your child may need to return to the hospital several times to finish the tests for a full evaluation.

The hepatologist and surgeon will review the test results with you and answer any questions you may have. 

Once the evaluation is complete, the transplant team discusses each case to decide if your child is a good candidate to be added to national waiting list for available livers. Once on the United Network for Organ Sharing (UNOS) waiting list, you will be notified by our team.

Parents with children on the waiting list will receive instructions about getting a pager and the importance of letting the team know about changing health conditions. Since a donor liver may become available at any time of the day or night, you must always be available. The wait time for a donor liver is typically less than one year. Per SRTR, our median wait time to transplant is 5.1 months. 

When a donor liver becomes available, careful testing is done to ensure that the organs are not damaged in any way. Then, the organ is matched to a transplant candidate on the waiting list who is of compatible size and blood type. In some cases, the team may conclude that the donor liver is not suitable. If this happens, the transplant will be cancelled. If a cancellation happens, remember that it is in your child's best interest.

Before your child's surgery, the care team will prepare your child for surgery.

This includes:

• Talking with the admitting doctor
• Drawing blood samples
• Taking chest x-rays
• Collecting a urine sample
• Swabbing the nose and throat for viral tests
• Starting an IV

This can be a stressful time for your child. The nurses and other caregivers will minimize the stress of these procedures, but we know your child is best comforted by you. 

The liver is an organ that can grow and regenerate after being split in two! Often times a family member or close friend may consider donating part of their liver to your child. Living donor liver transplantation allows surgeons to perform the transplant without the wait time for a deceased liver. During the transplant evaluation, we will discuss living donor transplant options.

Donor safety is of primary concern throughout the process. Donors must be in good health, have a blood type that's compatible with the recipient and be motivated to donate by unselfish reasons. If live donation is suitable for your child, a donor evaluation will start after all your child's testing is complete. If the transplant team determines the donation is a good option, a surgery date is scheduled for both your child and your child's donor. Living donation usually takes less than 6 months. This whole process usually takes up to six months.

Learn more about living donation >

When it’s time for your child’s transplant, you’ll be with your child until it’s time for him or her to go to the operating room. While your child is in surgery, the operating room nurses will update you on the progress of the surgery. Transplants can take anywhere from 4 – 12 hours.

After surgery, your child will go to the pediatric intensive care unit (PICU) for close monitoring during the next few days. When your child’s condition is stable, they will be transferred to the immunocompromised unit (ICS). While your child is recovering, caregivers will teach you how to care for your child at home. 

Everyone recovers from liver transplantation differently. Depending on your child's condition, he or she will be hospitalized for two to three weeks following the transplant. We encourage you to stay within the Salt Lake City area for two to three months after the transplant. Our social workers will assist you with temporary housing.

Your child will have blood drawn often for the first 2-3 months and will be seen in the Transplant Clinic one to two times per week. The number of blood tests and clinic visits will decrease as your child’s condition becomes stable. You will be notified about any adjustments in your child's medications.

Even years after transplant, your child will have lab tests at least once every 3 months and visit the transplant clinic every 6 months. Transplant-related issues become less likely as time passes, but may occur for the rest of your child’s life. Regular follow-up lab work and clinic visits are the best way to find any problems as early as possible.

A liver transplant gives children a second chance at life. The care they need after transplantation will seem overwhelming at first, but families soon fall into a routine. The liver transplant doctor will tell you when your child is safe to return to school (usually within 6 weeks after leaving the hospital). Learning about transplantation will be a continual process throughout your child’s life. Joining support groups and talking with social work professionals can help you and your family through this difficult but rewarding process.

Potential Complications

Complications can occur with any kind of surgery, and patients undergoing organ transplants may face additional complications. The life-threatening disease that created the need for your child's transplant may affect the functioning of other body systems. Other problems, such as rejection of the new liver, may also happen.

Some possible transplant complications and medication side effects include: 

• Hemorrhage — One function of the liver is to make chemical components used to help blood clot, called clotting factors. When a liver fails, the ability to make clotting factors is weakened. To correct this problem, your child will receive blood products before, during, and after surgery. We expect the new liver will start working very quickly to help prevent any excessive bleeding, but your child may need to return to surgery to control the bleeding, particularly if it occurs within the first 48 hours after transplant.
• Thrombosis — If a blood clot forms in a vessel leading to or from your child's liver, this may injure the new liver.  This is considered a serious complication that may require a second transplant. Your child will receive special anticoagulation medication to prevent this from happening.
• Rejection — Your child's immune system protects him or her from invading organisms. Unfortunately, it also views the new liver as foreign and will try to destroy it in an attempt to protect your child. This is known as rejection. To prevent this from occurring, your child must take special immunosuppressive medication for the rest of his or her life.

Liver rejection often happens with no outward symptoms. Therefore, it’s important to have lab tests regularly. Prevent rejection by:

• Giving your child all medicines as the doctor prescribed
• Keeping follow-up appointments
• Calling the transplant office immediately if you notice any signs of rejection

Your child may need a liver biopsy to diagnose rejection. The liver transplant team can treat rejection with medication adjustments. Your child may also need to be hospitalized to prevent continued development of rejection, if possible.

Immunosuppressive Medications

Immunosuppression drugs decrease your child's resistance to foreign bodies, such as the new liver. Your child will need to take these medications for the rest of his or her life or the liver will be rejected. Immediately after surgery, the doses will be high since the chance of rejection is greatest at this time. Dosages will be lowered quickly once clinicians determine a low risk of rejection.

The medications have side effects, which are usually dose-related. Most people experience the most side effects in the beginning when medication dosages are high. As the dosage is lowered, the effects will lessen. Side effects may occur in some patients and not in others.

Immunosuppressive medications also weaken the child's ability to fight off infections. Your child will be given medication to help prevent infections, but also use caution and avoid contact with people with infections, especially during the first three to six months after transplant.