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Guidelines for sites linking to mayoclinic.orgPreparation for this treatment option begins with a survey of medical and family issues to determine how best to help the child with liver disease. An extensive evaluation is necessary to determine the cause of the liver problem, the need for a transplant, and the chances for a successful outcome after transplant.
The following elements are commonly part of the evaluation. Many tests can be performed by outside health care facilities, but several studies must be done by our staff:
This evaluation may be done in as little as three days in Rochester or it may occur in stages over a longer period of time.
While preparing for the transplant, the transplant team educates the patient and family about the care that the child will require at home and at school after surgery. Supportive care is organized with the home medical team to optimize health until the operation can be performed.
Children requiring liver transplantation are cared for at the Mayo Eugenio Litta Children's Hospital. This outstanding facility opened in 1996 within the St. Marys Hospital campus and provides a full range of pediatric specialty care in a family-friendly atmosphere.
Children may stay in the Pediatric Intensive Care Unit or in other age-appropriate areas (e.g., adolescent, toddler, infant) of the hospital during their recovery. Rooming-in and liberal family visiting allow an ideal supportive environment for the family.
Children receiving a liver transplant at Mayo typically stay in the hospital about 10 to 14 days after surgery. After a few days of intensive care these children begin a progressive program of activity and education. Staff explain the home-going medicine schedule and an orientation program to make the patient and family comfortable and confident with outpatient care.
There are several approaches to liver transplantation, and it is important for family members to understand these different approaches.
Cadaver-organ liver transplantation
In this type of operation, surgeons implant a donor's entire liver in the recipient. This is very similar to normal liver anatomy, except that a drain is temporarily placed in the duct to decompress the network of bile ducts. At times, the bile duct is connected directly to the intestine with a Roux-en-Y (pronounced ROO-en-why) reconstruction.
This technique is similar to a reduced-size liver transplant. The difference is that a single liver is divided in such a way that it can be used for two transplant recipients. This technique is useful when the whole liver would be too large, and two suitable recipients are waiting for transplant.
This allows surgeons to implant a liver that would otherwise be too large for a small recipient. Surgeons remove a portion of the donor liver. This diagram shows the typical divisions within the liver that allows the surgeon to remove a portion of the liver graft. This is a common scenario for young children needing liver transplant, and several different techniques may be used to accomplish this goal. All of these approaches require careful preparation of the donor liver and special techniques for implantation. The greater complexity of this type of operation introduces some additional risk of complications, but success rates have been excellent.
In larger children and adolescents, the surgeon can divide the liver and implant only one lobe in the recipient. Typically either the left or right lobe is used, depending on which is the best fit.
In very small children the surgeon will sometimes choose to implant only a liver segment, rather than an entire lobe. This is usually the left lateral segment or about 20 percent of the liver.
Because each child's situation is unique, this important issue can only be addressed in the broadest terms here. During your visits with Mayo Clinic staff, the family will have ample opportunity to discuss your child's specific situation with many experienced professionals. The following general information usually applies:
Children typically remain in Rochester for two to four weeks after they leave the hospital. During this time, families usually stay at the nearby Ronald McDonald House, Gift of Life Transplant House, or a local hotel.
Frequent outpatient visits continue, along with occasional X-ray and ultrasound exams. Educational activities are completed so that the family feels comfortable giving medicines, taking measurements like blood pressure and encouraging healthy eating and activities.
We expect all liver transplant recipients to need lifelong treatment with medicine to prevent rejection of the liver. Some side effects are often seen in children, but it is uncommon for these to be a significant threat to health or quality of life. Most patients require additional medicines, but the need for these generally decreases over time.
By the time they leave Rochester, most children are active and playful. They are usually restricted from vigorous exercise for about two months, and occasionally from contact sports. Most children are able to return to school and other activities after six to eight weeks, depending on how ill they were before the transplant.
Mayo's physicians stay in close contact with your family physician, who can resume regular care at home. At first, children must have lab testing three times per week. Eventually, lab tests are needed only once a month. Patients usually must return to Mayo for evaluation four months after transplant, yearly on the anniversary of surgery, and when the home physician recommends it.
Although we keep the transplant recipient's immune system under control with medicines, it is uncommon for these children to be "sickly." They are restricted in their normal daily activities to only a small degree. During the first six months after transplant you should avoid crowded settings where colds or flu might be easily spread.
Some health problems are commonly seen in transplant patients, like high blood pressure, acne and delayed growth, but it is rare for these complications to become serious. Some changes in childhood immunizations are required, and special precautions about exposure to chickenpox may be necessary.
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