Transplant

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, however because there are no medications that cure liver failure, a liver transplant may be necessary.

An evaluation is the first step in helping you and your child determine whether a transplant is the best treatment. 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.

Most of our liver transplants 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.

Your child’s transplant evaluation may include:

• Blood tests
• Chest X-ray
• Electrocardiogram
• Pulmonary function test
• Ultrasound

Your child will see the following:

• Hepatologist
• Transplant surgeon
• Transplant pharmacist
• Social worker
• Dietitian
• Financial counselor to review your insurance information
• Heart, kidney, genetics, and infectious disease consults

The hepatologist and surgeon will review the test results with you and answer any questions. When the evaluation is complete, the team will 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 the importance of letting the team know about changing health conditions. Since a donor liver may become available at any time, you must always be available.

The wait time for a donor liver is typically less than one year. Stated by the Scientific Registry of Transplant Recipients (SRTR), our median transplant wait time is 5.1 months.

When a donor liver becomes available, 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 compatible. 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. Our nurses and other caregivers work hard to keep child comfortable and minimize the stress of these procedures.

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

Donor safety is a 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 a 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. This whole process usually takes less than six months.

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

After surgery, your child will go to the pediatric intensive care unit (PICU) for close monitoring over 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, they 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.

For the first 2-3 months, your child will be seen in the transplant clinic one to two times per week for tests and blood work. The number of blood tests and clinic visits will decrease as your child gets stronger. We will work with you and communicate any care and medication changes.

After the transplant, your child will have lab tests at least once every 3 months and visit the transplant clinic once every 6 months. Although transplant-related issues can occur at any time during your child’s life, they become less likely as time passes. Regular follow-up lab work and clinic visits are the best way to find any problems, early.

A liver transplant gives children a second chance. The care they need after will seem overwhelming, but we’re here to help you and your family. Because learning about care for your child will be a continual process, joining support groups and talking with our social work professionals can help.