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Liver transplant in children – The Times of India

TNN | Jul 31, 2014, 03.31PM IST

The first human liver transplant operation was carried out on an adult in the USA in 1963. The first liver transplant on a child took place five years later. In India, first successful paediatric liver transplant happened in 1998.

When do children need liver transplant: Common indications in children are cholestatatic liver diseases. Cholestatic liver disease is a condition in which a specific bilirubin called conjugated (direct) bilirubin remains persistently high. Biliary atresia is a condition in which the tiny tube connecting the liver and the small intestine is missing. As a result of which bile, which excretes bilirubin, does not reach small intestine and the child becomes jaundiced. Biliary atresia is the most common indication for liver transplant in children. It is also the most common condition requiring liver transplant in the first year of life. The other conditions include acute liver failure from multiple causes, metabolic conditions involving the liver like Wilson disease, cystic fibrosis, some glycogen storage disease, tumours in children and other diseases causing chronic liver disease.

The surgery: Liver transplantation is a major form of surgery. It is considered when other forms of treatment are ineffective or when a child can no longer lead a good quality of life. The aim of liver transplantation is to return a child/ to health with an improved quality of life. Childhood vaccinations are expedited if not administered yet. If the baby/child is malnourished then extensive nutritional rehabilitation is done before the transplant. A donor also has to undergo various tests to judge the suitability for transplant. After all these, a liver transplant is performed. The surgery can last between 8- 12 hours.

After surgery: The child is then shifted to a liver ICU. This allows your child to rest completely after the operation and be closely monitored over this critical period with close monitoring. The stay is variable but generally is between 1-2 weeks. He /she is then shifted to ward for further care. The duration of stay is variable but generally the child is discharged before three weeks. The child needs to be on medicines on a daily basis so that the body does not reject the new liver. After discharge it is time to return to a ‘normal’ life.

Success rate: With newer surgical techniques and better anti-rejection medicines the immediate success rate is in the high 90s.

By — Dr Rajeev Tomar, Senior Consultant-Paediatrics, Fortis Hospita, Noida

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