Pediatric liver

The Centre for Liver Disease & Transplantation is a 'Centre for excellence' in the treatment of pediatric liver, biliary and pancreatic disorders. We are a multi-disciplinary group offering comprehensive evaluation and multi-modality treatment options ranging from medical optimization of chronic liver disease to minimally invasive and laparoscopic surgical treatment of liver, biliary disorders as well as living donor and cadaveric split liver and multi-organ transplantation. Our doctors are super-specialists trained at the world's finest institutes and they are rated as the best in their respective areas of specialization.

A true 'centre for excellence', this unit is equipped with the 'latest and the best' in facilities & equipment required to deliver the most comprehensive program aiming at results that are 'second to none' on the planet. We have a 320 slice CT scanner, a 'state of the art' liver intensive care unit & operation theatre. Various surgical tools to enable safe & bloodless liver surgery including 'cavitron ultrasonic surgical aspirator, argon laser coagulation, ultrasonic blood vessel sealing systems' etc.

What is a liver?

The liver is the largest internal organ in your body. An average adult liver weighs approximately 2% of the total body weight. It is located in the right side of the abdomen just beneath the diaphragm and behind the lower ribs. The liver has a right and a left lobe. Beneath the liver lies the gall bladder which is the reservoir for bile.

What does the liver do?

The liver is responsible for many of the body's metabolic and manufacturing functions including:

The metabolism of carbohydrates into glucose (sugar) so your body can use it for energy.
Detoxification (cleaning) of harmful substances from the body, this includes alcohol, drugs including the products from what you eat and drink.
Production of bile, a yellow-green substance that helps your body absorb fats
Metabolism and production of proteins, including proteins that aid in blood clotting
Maintenance of normal balance of hormones.
Filtering blood to remove bacteria and other particles.
Storage of minerals and vitamins for your body's use later on.
Host defense to assist in fighting infection

What is acute/fulminant liver failure?

Fulminant liver failure is potentially life threatening condition. Because of liver failure, toxins accumulate in the blood and cause brain to swell. If not treated in timely fashion with liver transplant, patients succumb. Common causes for fulminant liver failure aree paracetamol poisoning, acute hepatitis B, and Wilson's disease etc.

What are the common causes of liver disease needing liver transplant in children?

Common indications for liver transplantation in children can be classified into three categories, cholestatic liver diseases like biliary atresia, PFIC, Wilson's disease, alligile syndrome, alpha 1 antitrypsin deficiency, hemochromatosis, tumors like hepatoblastoma, metastatic neuroendocrine tumors etc and metabolic syndromes like MSUD, certain urea cycle defects, crigler najjar syndrome, familial hyper cholestorelemia etc.

Why do liver transplant for children with biliary atresia?

The bile ducts fail to grow in some children. Some children respond to Kasai procedure (Porto enterostomy) for variable period of time. Majority of them progress to end stage liver disease and will need liver transplant.

How will I know if kasai procedure for my child is working?

If bilirubin is >2mg/dl, jaundice is worsening, worsening ascities (fluid in the abdomen), vomiting of blood, not eating well and not growing well are clear cut signs that liver disease is worsening and are indications for liver transplantation.

How safe is liver transplantation in children and what is the success rate?

Majority of the children tolerate this kind of surgery very well. We have highly trained and dedicated surgeons, anesthetists, and pediatric intesivists to take care of your child. We also have state of the art operation theater and intensive care facility and the best available machines in the world. All of them contribute to care for your child. Success rate is higher if transplant is done in a timely fashion. Overall success rate is >95% at 1 year in very experienced centers.

How do we get liver for our child?

Most of the children need either left lobe of the liver or left lateral segment of an adult liver. These livers can come from either a brain dead person or from a live donor. Waiting time for cadaver donor liver may be very long and may compromise the success of your child`s surgery. While live donor liver transplant is absolutely safe and it can be done when your child is fit. This will definitely improve your child`s outcome.

What is the duration of liver transplantation surgery?

From the time you move into the operation theatre, till we finish surgery it takes about 8 to 10 hours. After making an incision resembling the inside of 'Mercedes Benz' sign, the liver is mobilized and disconnected from its blood vessels and the bile duct. Then the new liver is put in and all the necessary connections are made, which include hepatic vein, portal vein and hepatic artery. Bile duct is either connected to the recipient's bile duct or to a loop of the small intestine. Drains are then placed and your abdomen is closed in layers.

Will our child grow well?

The liver will grow with your child. With appropriate treatment, it is possible for your child go to regular school, grow like any other person and do a job. They can have normal relationship and females can even have children.

How safe is live donor liver transplant?

Donor safety is our priority. We perform appropriate tests to ensure safety of both the donor and recipient. We go ahead only if it absolutely safe for both of them. The data from all over the world estimates the risk for the donor to be around 0.2% to 0.3%. The remnant liver of the donor will grow back to almost its full size in about 6 weeks. The piece of the liver the recipient gets will also grow to meet his requirement.

What is the quality of life for live donor after the surgery?

The donor stays in the hospital for about 1 week. They take about 3 to 4 weeks to recover fully and get back to work. There is no long term risk and there is no need to take any medications.

Which is better? Live donor or Cadaver donor liver transplant?

The outcomes are comparable. Live donor liver transplant can be planned and performed when the recipient is medically optimized so that the outcomes are optimal. While in cadaver donor liver transplant, we will not be able to predict the timing. Demand is more and supply is less. As per the government`s regulations, we maintain a list of our recipients and the livers are allocated on first come first served basis.

Long term prognosis

What happens after the surgery?

After the surgery is over, your child will be taken to liver transplant ICU. He/She will still have breathing tube in. There will be a few tubes in your neck (used for giving fluids and medicines); they will also be used to monitor your heart function. Once we are sure that your liver is functioning just fine and bleeding has stopped, we will wake you up and take the breathing tube out. After that, we will start your child on oral diet and start immunesupression medications.

How long do we stay in the hospital?

Typically recipients stay in the hospital for 10 to 14 days.

What are the complications?

Immediate post operative complications are bleeding, bile leak, and hepatic artery thrombosis. Bleeding most often settles on its own with appropriate medical management. Sometimes we may have to re-explore to control bleeding. Bile leak can be treated with ERCP but sometimes may require re-operation. Hepatic artery thrombosis (HAT), if identified early, will need re-exploration to take out the clot and to reanalyze it. If it continues to clot, most of them will require urgent re-transplantation. Fortunately, HAT is very rare.

How long our child will have to take medicines?

Your child will need to take medicines for rest of their life. These medicines (immune suppressants) help your body get used to the new liver. In the first three months, there will be a number of medicines. Our aim is to get it down to one medicine at the end of one year.

What precautions do we take after discharge?

Once we are satisfied with your surgical recovery, we teach you and your family about the kind of care your child needs, hygiene required and to be maintained at home and we also will teach you everything you need to understand regarding his/her medicines. Our dietician will teach you about the foods that you can give your child and what you need to avoid. Physiotherapist will teach you some health maintenance exercises.