Life after Liver Transplantation
What happens during liver transplant surgery for a child?
Once a liver is available for your child, you and your child will be told to go to the hospital right away. This call can occur at any time, so you should always be ready to go to the hospital. At the hospital, your child will have some more final blood work and tests to be sure the liver is a match.
Your child will then go to into surgery. The transplant may take several hours. This will vary depending on your child’s case. During the surgery, a member of the transplant team will let you know how the surgery is going.
Liver transplant surgery requires a hospital stay. Procedures may vary. It depends on your child’s condition and the provider’s practices.
Generally, a liver transplant follows this process:
- Your child will be asked to remove his or her clothing and given a gown to wear.
- An IV or intravenous line will be started in your child’s arm or hand. Other tubes or catheters will be put in the neck and wrist. Or they may be put under your child’s collarbone or in the groin area. These are used to check your child’s heart and blood pressure, and to get blood samples.
- Your child will be placed on his or her back on the operating table.
- A catheter will be put into your child’s bladder to drain urine.
- Your child will be given general anesthesia so that he or she is in a deep sleep. After your child is sedated, the anesthesiologist will put a tube into your child’s lungs. This is so that your child’s breathing can be helped with a machine called a ventilator. The anesthesiologist will keep checking your child’s heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
- The skin over the surgical site will be cleaned with a sterile solution.
- The doctor will make a cut or incision just under the ribs on both sides of your child’s belly. The incision will extend straight up for a short distance over the breast bone.
- The doctor will carefully separate the diseased liver from the nearby organs and structures.
- The attached arteries and veins will be clamped to stop blood flow into the diseased liver.
- Different surgery methods may be used to remove the diseased liver and implant the donor liver. The method used will depend on your child’s specific case.
- The diseased liver will be removed after it has been cut off from the blood vessels.
- The surgeon will check the donor liver before implanting it in your child’s body.
- The donor liver will be attached to your child’s blood vessels. Blood flow to the new liver will be started. The surgeon will check for any bleeding where there are stitches.
- The surgeon will attach the new liver to your child’s bile ducts.
- The surgeon will close the incision with stitches or surgical staples.
- A drain may be placed in the incision site to reduce swelling.
- A sterile bandage or dressing will be applied.
What happens after a liver transplant for a child?
After the surgery, your child will go to the intensive care unit (ICU) to be watched closely. The length of time your child will spend in the ICU will vary. It is based on your child's condition.
After your child is stable, he or she will be sent to the special hospital unit that cares for liver transplant patients. Your child will still be watched closely. During this time, you will learn all about caring for your child. This will include information about medicines, activity, follow-up, diet, and any other instructions from your child's transplant team.
Your child's body may try to reject the new liver. Rejection is a normal reaction of the body’s immune system, or disease-fighting system, to a foreign object or tissue. When a new liver is placed in your child’s body, the immune system thinks it is a threat and attacks it.
To help the new liver survive in your child’s body, your child must take anti-rejection medicines. These are called immunosuppressants. These medicines weaken the immune system’s response. Your child must take these medicines for the rest of his or her life.
Rejection is more likely to occur in the weeks right after surgery. But rejection can occur at any time that anti-rejection medicines are not able to control the immune system response.
Symptoms of rejection
It may not always be easy to tell when rejection occurs. High liver enzyme levels in the blood may be the first sign of rejection.
It is important for both you and your child, when he or she is old enough, to know the signs and symptoms of rejection. Symptoms may vary. Some common symptoms of rejection may include:
- Yellowish skin or eyes (jaundice)
- Dark urine
- Light-colored stools
- Swollen or sore belly
- Extreme tiredness or fatigue
- Feeling grouchy or irritable
- Upset stomach or nausea
The symptoms of rejection may seem like other health problems. Your child's transplant team will tell you who to call right away if any of these symptoms occur.
Your child must take anti-rejection medicines for the rest of his or her life. The doses of these medicines may change often, depending on your child's response. Each child may react differently to medicines. And each transplant team may prefer different medicines.
Your child will have blood tests from time to time. These will measure the amount of medicine in your child’s body. This is to make sure your child gets the right amount of medicine. White blood cells are also an important sign of how much medicine your child needs.
Anti-rejection medicines affect the immune system. So children who have a transplant are at greater risk for infections. This risk is very high in the first few months after surgery. That’s because higher doses of anti-rejection medicines are given during this time.
For the first few months after surgery, your child should avoid crowds or anyone who has an infection.
Your child will most likely need to take medicines to prevent other infections from occurring. Some of the infections your child will be at greater risk for include:
- Thrush or oral yeast infection
- Respiratory viruses
- CMV or cytomegalovirus
- EBV or Epstein-Barr virus
Living with a liver transplant
Living with a liver transplant is a lifelong process. Your child will have to take anti-rejection medicines so that the immune system won’t attack the new liver. Other medicines must be given to prevent side effects of the anti-rejection medicines. These side effects include infections. It’s important that you and your child keep in close contact with the transplant team.
When your child is old enough, he or she will need to learn all about anti-rejection medicines and what they do. Your child will have to learn the signs of rejection, and everything else you have learned. This is important so that your child can one day care for himself or herself without help.
Before you agree to the test or the procedure for your child make sure you know:
- The name of the test or procedure
- The reason your child is having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- When and where your child is to have the test or procedure
- Who will do the procedure and what that person’s qualifications are
- What would happen if your child did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or your child has problems
- How much will you have to pay for the test or procedure