The success rate of liver transplantation for children reaches 95 percent, which is considered very high for such a delicate surgery.

Liver Transplant Surgery for Children
Liver transplantation saves the lives of many children and newborns. It is performed for various purposes to treat several medical conditions, including genetic diseases a child is born with or liver failure due to infectious diseases contracted before or after birth.

The child may receive the transplanted liver either from a living donor (usually a family member) or from a deceased donor.

Extensive examinations are performed on the donor before surgery to ensure their health and compatibility with the patient, to prevent rejection of the transplanted liver.

The patient’s immune system may attack the transplanted organ, and in severe cases, this could lead to death if there is no compatibility. However, mild rejection cases can be managed with immunosuppressive medications.

Indications for Liver Transplantation in Children
Liver transplantation in children is performed for several purposes, the most common being genetic disorders or liver failure due to infection during or shortly after birth.

The most common indications include:

• Biliary atresia: a blockage in the bile ducts causing symptoms like liver enlargement, jaundice, pale stools, and dark urine.
• Inherited metabolic disorders, including:
  • Wilson’s disease
  • Alpha-1 antitrypsin deficiency
  • Tyrosinemia
  • Hemochromatosis
  • Crigler-Najjar syndrome
  • Glycogen storage disease
  • Primary hyperoxaluria
  • Familial hypercholesterolemia
  • Methylmalonic acidemia

Steps of Liver Transplantation in Children

1. Anesthesia
   The surgery is performed under general anesthesia.
   • In living donor cases, both donor and recipient are prepared and anesthetized simultaneously.
   • In deceased donor cases, the liver can be preserved for up to 12 hours until the child is ready.
2. Surgery
   The diseased liver is removed and replaced with the new organ in the same location. The transplanted portion is connected to the child’s blood vessels, and bile ducts are attached to the intestines.
3. Postoperative Care
   The child stays on a ventilator for 24 hours in the pediatric ICU, then continues in the hospital for about two weeks. Feeding can begin orally from the second week.
4. Medications
   After surgery, the child must take lifelong immunosuppressive medications such as:
   • Mycophenolate mofetil (CellCept)
   • Prednisone
   • Tacrolimus
     These prevent rejection of the new liver.

Complications of Liver Transplantation

1. Rejection
   • The immune system may attack the new liver.
   • Can be acute (severe, sometimes fatal) or chronic (manageable with medication).
2. Surgical Complications
   • Bleeding or clotting in liver blood vessels.
   • Leakage or blockage in bile ducts.
   • General risks: wound infection, anesthesia reactions, hernia.
3. Side Effects of Immunosuppressants
   • Infections (weakened immunity).
   • Tumors (due to reduced cancer-fighting capacity).
   • High blood pressure.
   • Lipid disorders (raising risk of heart disease).
   • Diabetes.
   • Kidney failure.

Liver Transplantation in Infants
The causes differ slightly from older children and often include:

• Neonatal hepatitis
• Acute hepatitis from bacterial infection during or after birth
• Congenital metabolic errors
• Neonatal hemochromatosis

Success Rates

• Children: 95% survive after one year, 90% survive after five years.
• Adults: 89% survive after one year, 75% survive after five years.

This shows liver transplantation outcomes are generally more successful in children compared to adults.

Conclusion
Liver transplantation is the only life-saving solution for many children with severe liver diseases. Despite being a highly complex surgery with potential complications, the success rate in children is very high, offering them a chance for a healthier life.

Sources:

• Indication of pediatric liver transplant
• Indication of neonatal liver transplant
• Complications of immunosuppression after organ transplant
• Success rate of pediatric liver transplant