Liver transplantation, first performed in 1963, provides an opportunity for a longer, more active life for people in the final stages of liver disease. Advances in surgical techniques and new medications that prevent the body from rejecting the transplanted organ have greatly improved success rates.
The largest organ in the body, the liver performs many complicated functions, including processing proteins, fats and carbohydrates and breaking down toxic substances such as drugs and alcohol. In addition, the liver makes the chemical components that help blood to clot. If the liver fails, the body loses the ability to clot blood as well as to process nutrients needed for life.
The liver also excretes a yellow digestive juice called bile, which may accumulate if the liver is not working properly. The eyes may become "jaundiced" or yellow, or the skin may itch from the accumulated bile. Some medications help treat the symptoms of liver failure, but there are no drugs that cure liver failure.
There are hundreds of liver illnesses that may result in end-stage liver disease, but biliary atresia, a birth defect in which the bile ducts fail to develop or develop abnormally, is the most common cause for children's liver transplants at our hospital.
If your child's liver begins to fail, he or she may be eligible for a liver transplant that could involve a relatively new procedure called a "living donor" transplant. In living donor liver transplantation, a piece of liver is removed from a living donor and transplanted into a recipient. Because the liver can regenerate itself, the piece of liver that remains in the donor quickly grows back to its original size. Transplant livers may also come from someone who has died, called a cadaveric donor.
In the future, alternative therapies such as artificial liver assist devices, cellular transplantation techniques and genetic modification of hepatocytes may become viable approaches to treating children with end-stage liver disease.
Most liver transplant patients at UCSF are referred to the program by primary care doctors or by a specialist. When a referral is made, a transplant program coordinator will call you to schedule an appointment, typically on a Tuesday.
A preliminary evaluation is the first step in helping you and the transplant team determine whether transplantation is an appropriate treatment for your child. It also enables the transplant team to assess the medical factors related to your child's liver failure. Not everyone who is evaluated for a liver transplant actually needs one. Your initial appointment will help determine your child's treatment options.
The preliminary evaluation will take a full day, from about 8 a.m. to 4 p.m., and can be very tiring. The following tips will help you prepare for this first appointment:
Your child's surgery may take from four to 12 hours depending on his or her condition. During surgery, your child's old liver and gallbladder will be removed and replaced with the donor liver. Since a gallbladder is no longer needed, a new one will not be transplanted.
After surgery, your child will go directly to the intensive care unit (ICU), usually for one to two days. Immediately after surgery, a breathing tube will be inserted to help him or her breathe. In most cases the tube can be removed within 24 hours after surgery. Many monitoring lines will be attached; these, too, will be removed as your child becomes more stable. When your child is ready to leave the ICU, he or she will be cared for on either the sixth or seventh floor of the hospital.
Everyone recuperates from liver transplantation differently. Depending on your child's condition, he or she will be hospitalized for two to eight weeks following the transplant. Most children stay within the San Francisco Bay Area for two to six weeks after the transplant and then are referred back to their primary care doctor and referring physician. Our social workers will assist you with temporary housing.
Once your child has returned home, we work with your primary doctors to ensure that your child receives optimum care, both for the liver transplant as well as issues related to normal growth and development.
Laboratory blood tests are obtained twice a week following transplantation; the frequency of blood tests is gradually reduced over time. You will be asked to call in test results to the transplant office. You will then be notified about any adjustments in your child's medications.
Reviewed by health care specialists at UCSF Benioff Children's Hospital.