Paediatric Liver Transplant

Liver disease in children does not always progress rapidly. In many cases, it is managed for months or even years with medicines, nutritional support, and regular follow-up. However, there are situations where the liver gradually loses its ability to function. When this happens, complications arise, and treatment options become limited.

A paediatric liver transplant may then be considered. The procedure involves replacing the damaged liver with a healthy donor liver. It is not advised routinely and is only planned after careful medical review. At Gleneagles Hospitals, the transplant team evaluates each child individually before recommending transplantation.

Paediatric liver transplant is a surgical procedure in which a child’s diseased liver is removed and replaced with a healthy liver from a donor.

The donor may be:

• A deceased donor

• A living donor, usually a parent or close relative

In living donor transplantation, only a segment of the liver is removed from the donor and implanted into the child. The liver has the ability to regenerate, and over time, both the donor’s remaining liver and the transplanted portion grow to an adequate size.

Depending on the child’s age and overall build, surgeons may use either an entire donor liver or a reduced segment. The choice is guided by size compatibility and clinical need. The objective is to re-establish stable liver function in situations where medical treatment is no longer sufficient to reverse the disease process.

Transplantation is usually discussed when liver function continues to decline despite ongoing treatment. The decision does not rely on a single factor. Instead, doctors review the child’s clinical course, blood test trends, imaging results, and general condition before determining whether transplant offers the safest long-term option.

Doctors may advise evaluation for transplant in the following conditions:

• Biliary atresia 

• Acute liver failure caused by viral infection or drug toxicity

• Wilson's disease and certain metabolic disorders

• Progressive familial intrahepatic cholestasis

• Autoimmune hepatitis is not responding to treatment

• Selected liver tumours confined to the liver

Children with advanced liver disease may experience persistent jaundice, abdominal distension due to fluid accumulation, poor weight gain, recurrent bleeding episodes, or repeated infections. When these issues become difficult to control, transplant assessment is undertaken at Gleneagles Hospitals.

Transplantation is not the immediate course of action for every child with liver disease. Quite often, the condition can be managed for a considerable time with medicines and supportive care. It is generally when the disease continues to progress, or when complications begin to outweigh the benefit of conservative treatment, that a transplant evaluation is pursued. The anticipated benefit must justify proceeding with major surgery.

• Children often considered for transplant include:

• Advanced chronic liver disease with progressive functional impairment

• Acute liver failure that continues to deteriorate despite intensive supportive treatment

• Recurrent bleeding episodes related to portal hypertension

• Poor weight gain or linear growth failure associated with longstanding hepatic dysfunction

• Selected metabolic liver disorders in which replacing the liver alters disease progression

At Gleneagles Hospitals, the pre-transplant assessment involves review of laboratory trends, imaging to evaluate hepatic structure and vascular flow, screening for infection, and cardiopulmonary evaluation. Nutritional status is reviewed as part of the assessment. The family is also counselled about the long-term care and follow-up required after transplantation.

Although paediatric liver transplantation is well established, it may not be appropriate in every situation.

Doctors may postpone or avoid transplant in children who:

• Have uncontrolled systemic infections

• Have a severe irreversible failure of other vital organs

• Have advanced cancer outside the liver

• Are medically unstable at the time of evaluation

• Stabilisation and reassessment are necessary before proceeding in such cases.

The transplant is performed by a specialised surgical team. At Gleneagles Hospitals, the procedure is carried out in a dedicated operating theatre with paediatric anaesthesia and intensive care support.

Prior to the operation, a routine preoperative work-up is completed. This includes:

• Liver function testing and clotting profile

• Imaging to assess liver anatomy and blood vessels

• Blood group compatibility and donor matching

• Screening for infections

• Cardiac and pulmonary evaluation

• Parents are counselled regarding the surgical process, expected recovery, possible risks, and the need for lifelong medication. Questions are addressed before proceeding.

The surgery is done under general anaesthesia and can last a few hours.

The affected liver is separated from its attachments while preserving key vessels. The donor graft is positioned in place. Surgeons reconnect the hepatic veins to restore venous outflow.

• The portal vein is anastomosed to re-establish portal inflow.

• Arterial inflow is established by connecting the hepatic artery.

• The bile duct is then reconstructed so that bile can drain into the intestine.

• After these steps, circulation through the graft is established and carefully assessed.

• Blood pressure and blood loss are checked throughout the procedure.

The child is observed in the paediatric intensive care unit after surgery. Ongoing observation and laboratory review continue during early recovery.

Care includes:

• Liver function tests are checked regularly

• Fluid balance monitored and electrolytes corrected as needed

• Respiratory support if required

• Immunosuppressive medication started

• Hospital stay varies. It is guided by the child’s recovery pattern and the stability of graft function in the early postoperative period. 

At Gleneagles Hospitals, discharge is considered once graft function is stable and the child is tolerating feeds satisfactorily.

Paediatric liver transplantation is a complex procedure and carries recognised risks. Prompt identification of complications plays an important role in overall outcomes.

Possible complications include:

• Bleeding

• Bile leakage or biliary narrowing

• Vascular events, including hepatic artery thrombosis

• Acute rejection episodes

• Infection

• Adverse effects related to immunosuppressive medication

Rejection does not necessarily indicate graft loss. In many instances, it responds to therapeutic modification. Ongoing follow-up at Gleneagles Hospitals is structured to recognise and address such concerns at an early stage.

When undertaken at an appropriate stage of disease, paediatric liver transplantation may provide significant clinical improvement. It can:

• Restore functional liver activity

• Support improved appetite and growth

• Reduce complications such as ascites and bleeding

• Enhance overall energy and daily functioning

With consistent follow-up and adherence to medication, many children can gradually return to school and age-appropriate activities.

Gleneagles Hospitals provides paediatric liver transplant services, supported by surgical, liver, and critical care teams.

Facilities include:

• Dedicated transplant operating theatres

• Paediatric intensive care units

• Living donor assessment services

• On-site laboratory and imaging support

• Post-transplant follow-up clinics

Each case is reviewed individually, with attention to surgical timing and postoperative care planning.

Paediatric liver transplant is considered in children with advanced liver disease when medical management no longer provides adequate control. The pathway includes clinical evaluation, surgical treatment, and continued follow-up.

Results depend on careful assessment and ongoing monitoring. At Gleneagles Hospitals, transplantation is advised after detailed review and discussion with the family.