A question of transplant In the first of a series of Liver Life articles featuring frequently asked questions, Aisling Rollason, health and research information manager at CLDF, highlights the key issues surrounding liver transplant. Why are liver transplants necessary?
The facts are: Almost all children’s liver transplants in the NHS can presently be satisfied by a conventional transplant, but sometimes children can’t wait any longer as they’re very poorly.
Liver transplantation is considered for those with chronic liver disease when other forms of treatment haven’t worked. Transplant may also be necessary for those with acute liver disease.
There are a few NHS children who undergo living related liver transplantation.
How is it decided who gets each liver?
Up to now, outcome results from a conventional transplant are similar to living related transplant with no real difference in the rate of rejection.
Many people believe that the waiting list is like a ladder; that a child’s name is added to the bottom rung and moves up the ladder when the person at the top receives a transplant. This is not always the case. When a donor liver becomes available the surgical and medical teams decide who is the most suitable recipient using criteria including: blood group, size, clinical urgency.
What are the different types of liver transplant? Whole Liver
In this type of transplant, the liver is an appropriate size for the child and the whole liver is used. Split Liver
Livers can be divided so that two patients can benefit from one donor. The liver can be split into two lobes with the right lobe being given to an adult or older child and the left lobe or a left lateral segment (part of the left lobe) to a child. The cut surfaces are sealed. The new piece of liver grows with the patient. Cut Down (Reduced Graft)
A liver can also be made smaller to be made the correct size for the recipient, however, in this type of transplant there is only one recipient. Living Related Transplantation
In some cases, it is possible for a relative, usually a parent, to give part of their liver to their child. The donor has to be carefully selected to see if they are suitable as this is not always the case. Many parents feel they would like to give part of their liver to their child, especially at a time when they are desperately anxious about their child’s survival. 12
There are risks to the donor.
If this is an option which you and your family would like to explore, speak to your transplant team who will be able to give you more information. Auxiliary Transplantation In certain types of liver disease, particularly some metabolic diseases, part of a donor liver can be transplanted alongside the child’s own liver. The transplanted liver is able to carry out the functions of the liver which are not performed by the child’s own liver. Such an operation may also be carried out where there is the possibility of the child’s liver recovering, as can occur in some cases of acute liver failure.
How long do you have to wait for a liver transplant?
There are more people in need of a liver transplant than there are donated livers, which means there is a waiting list. The average waiting time for a liver transplant (chronic liver patients) is 145 days for adults and 72 days for children. However, the waiting time may be a lot shorter if someone is on a high-priority waiting list. Acute liver failure patients can’t wait that long, they’re on a super urgent waiting list, the average waiting time can be 3-5 days; sometimes it’s longer for babies.
Where do children’s transplants take place?
There are three paediatric liver centres in the UK. All UK children’s transplants take place at one of these centres. King’s College Hospital, London Birmingham Children’s Hospital Leeds General Infirmary