Rejection of the liver - know the implications before the transplant

What is liver transplant?

Liver transplant is the replacement of the diseased liver with healthy liver from another individual. It is a valid treatment option for end stage liver disease and acute liver failure. In pediatric liver transplant there is replacement of diseased liver of a ​child. Liver transplantation has become an accepted standard of care in the treatment of a child with failing liver. Though this surgery is not indicated if other treatment alternatives are available or if certain contraindications are present.

Let us first discuss the indications for this surgery :​- The most common indication for liver transplantation is ​biliary atresia​. It is a disease of the liver in which one or more bile ducts are abnormally narrow, blocked or absent.

The second most common indication is ​metabolic disorders, ​i.e the deficiency of antitrypsin. It is basically a genetic disorder causing decreased activity in blood and lungs and deposition of abnormal proteins in liver cells.

Other less frequent indications are congenital hepatic fibrosis, postnecrotic cirrhosis, malignancies, neonatal hepatitis.

Contraindications of liver transplantation ​:- If other treatment alternatives are present, or certain malignancies, poor prognosis or outcome of the surgery.

Selecting a candidate for transplantation The appropriate time for surgery is when the child begins to show signs of fatigue, decreased activity level. Once the liver transplant is taken into consideration proper patient evaluation is done by a team of Hepatologist (liver specialists), transplant surgeons, nurses, psychologists, transplant co-ordinators. Once a pediatric patient is found to be a suitable candidate for a liver transplant the patient’s name is placed on the waiting list, but in most cases in our country especially, the donor is mostly from the family or a relative. The donor should be healthy, not obese, between 18 to 55 years of age. Most importantly either he/she should have the same blood group as the patient’s or should be ‘O’ positive.

Technique and Post- procedure care

The surgery is performed in general anaesthesia. Most commonly, liver transplants are performed orthotopically, meaning the new liver is placed in the same location as the diseased liver. The diseased liver is removed which is the most crucial part and can take several hours. The donor liver is then implanted, this implantation requires re-establishment of blood flow to the liver. After this is achieved the surgical part is complete and the patient is kept on ventilator for the next 24-48 hours and is constantly monitored. The patient is moved out of the pediatric ICU in a couple of days depending on his/her recovery. Oral intake can begin within the week following surgery. Prior to discharge follow up care and medication instructions are given. The possibility of rejection and it’s signs and symptoms are discussed with the parents. The patient is instructed to continue with rehabilitation program which includes exercise, following a proper diet, and taking the prescribed medications.

Problem associated : There are certain problems associated with this surgery, firstly the lack of donor. Secondly, due to infection or graft rejection the patient can die. There is always a risk of complication during or after surgery.

Outcome : The majority of the children lead a normal and healthy life after this surgery, but yes lifelong the child will have to take the required medications. But this is a small price considering that death would be their fate without liver transplant.

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