Liver transplantation is a surgical treatment which is employed in selective patients to combat acute and chronic liver failure caused due to any reason. This treatment is not advised to candidates for whom an acceptable alternative is available or if contraindications affecting the outcome of surgery are present. It has been documented that Pediatric patients account for about 12.5% of liver transplant recipients.
Disease states that develop into a full blown end – stage liver l disease among pediatric patients and require liver transplantation include patients with biliary atresia, metabolic disorders (Wilson disease, alpha 1-antitrypsin deficiency, tyrosinemia, and hemochromatosis) and progressive intrahepatic cholestasis.
Liver Transplantation is not advised or indicated to a patient, like mentioned before, if an acceptable alternative is available or if contraindications, such as malignancy, a terminal condition, or poor expected outcome exist.
Once the need for a transplant has been established, the following treatment, surgery, and postsurgical care can be broken into 4 basic steps for better understanding:
Candidate Evaluation : a special team evaluates the patient to determine whether the patient would be a good candidate for a successful liver transplant. The team may include specialists from various medical fields like: Hepatologists (medical liver specialists), Transplant surgeons, psychiatrists, Transplant coordinators
Waiting Period : For a liver transplant , once a pediatric patient is found to be a suitable candidate, the patient's name is placed on a waiting list for an organ. Candidates in the waiting list for donor livers are stratified according to the severity of their illness and blood type. This stratification of deceased organ donation was formulated by the United Network for Organ Sharing (UNOS) Medical urgency weighs more in the selection of a candidate for organ receipt more than the length of time a person has been on the waiting list.
Surgery : In liver transplant, mostly the new liver is placed in the same location as the diseased liver. And this process is termed orthotopic transplant. This requires that first the diseased liver has to be removed from the body. This is critical portion of the operation. Once the new liver has been transplanted with either the new liver "piggybacked" onto the cava or with new liver anastomosed to the native vena cava, the re-establishment of blood flow to the liver via the portal vein and hepatic artery and the reestablishment of blood flow away from the liver via the hepatic veins is an important part of the procedure. After the blood flow has been restored, the bile duct's continuity with the GI tract is established in pediatric transplantation via a hepaticojejunostomy.
Living donor grafts and split-liver grafts are A significant advance in transplantation and has yielded encouraging results in terms of graft viability. The use of living donation in pediatric transplantation is well established. It has also been documented that these give excellent results in the child
Post-Surgical Care : In Immediate Postoperative Care, patients frequently remain on a ventilator for the first 24-48 hours and are moved out of the pediatric ICU (PICU) in a few days, depending on their recovery. Oral intake may begin within the week following surgery. Hospital stays range from 1-2 weeks. Blood test are done to assess the medication regime, patient will be out on. Prior to discharge, the transplant team provides follow-up care and medication instructions. A rehabilitation program that includes exercise, proper nutrition, and the continuation of immunosuppression and other medications are advised to the patient.
Also, when a pediatric patient is likely to require a liver transplant, the treatment & management is divided into pre-transplant and post-transplant periods. The post-transplant period is further separated into early and late time frames.
In Pretransplantation Care, one works toward maximizing the nutritional status, which significantly impacts both pretransplant and posttransplant outcomes. This more so in the pediatric patients as there are increased incidences of cholestatic liver diseases.
The optimization of nutritional status in pediatric patients has greatly benefited and translated into improved survival after transplantation. There have been also fewer infections and a reduction of surgical complications has been noted.
Complications of liver transplantation includes, Hepatic artery thrombosis, Biliary complications, Infection, Nephrotoxicity, CNS toxicity, Osteoporosis, Cardiovascular disease, Lymphoproliferative disorders, Psychosocial stress.