June 20, 2024
Liver disease can affect children of all ages and has many negative consequences. Children who require a liver transplant can face many unique challenges and can benefit from Mayo Clinic's multidisciplinary expertise and extensive experience with pediatric and adult liver transplantation.
There are many reasons why a child may need a liver transplant. The main indications for a liver transplant are:
- Biliary atresia — A condition in infants in which the bile ducts inside and outside the liver become scarred and blocked.
- Hereditary disease.
- cancer.
- Acute liver failure.
“It's really important for these children to have a team that really understands these conditions,” says Dr. Samar H. Ibrahim, medical director of the pediatric liver transplant program at Mayo Clinic Transplant Center in Rochester, Minn. “It's also important to have the tools to make a rapid diagnosis and the experience and expertise to get a good outcome.”
At Mayo Clinic Children's Center, a multidisciplinary team of experts treats children with liver disease. The team includes pediatric gastroenterologists, pediatric hepatologists, pediatric registered nurses, physician assistants, pediatric nutritionists, psychologists, radiologists, transplant surgeons, and general surgeons. Other experts in pediatric specialties such as kidney, cardiac, and endocrine diseases are also involved. Mayo Clinic Children's Center offers cutting-edge diagnostic and interventional studies, including:
- A non-invasive, portable device for measuring liver fibrosis.
- Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive test to evaluate the bile ducts in the liver.
- Magnetic resonance elastography, which estimates liver stiffness and scar tissue formation, and other imaging techniques for imaging blood vessels, bile ducts, and tissues.
- Minimally invasive procedures performed by complex endoscopy specialists and interventional radiologists.
Mayo Clinic also offers innovative laboratory testing. “We can do ultra-rapid whole-genome sequencing,” says Dr. Ibrahim. “This is particularly useful for patients with acute liver failure in the newborn period, for example,” he explains.
Living donor liver transplantation
The number of children waiting for a liver transplant exceeds the number of livers available from deceased donors. Living donor liver transplants are an alternative to waiting for a deceased donor liver. With a living donor transplant, transplant patients can receive their new liver more quickly and avoid the health complications that can come with waiting longer for a deceased donor liver.
“Once patients are placed on the transplant waiting list, patients who receive living donor liver transplants have excellent outcomes,” says Julie K. Heimbach, MD, transplant surgeon and director of the Transplant Center at Mayo Clinic in Rochester, Minnesota.
Living donor liver transplants were first performed in children, and they are still performed in more children than adults who need a liver transplant.
“In pediatric liver transplants, the anatomy of the recipient and donor are particularly important,” Dr. Heimbach explains. “The key is that in most cases, adults who donate livers to pediatric transplant recipients are able to donate smaller portions of their livers. In donors, the liver usually regenerates completely in about six to eight weeks.”
Although outcomes after liver transplants in children are excellent, children who receive a new liver will need to take immunosuppressant medication for the rest of their life to prevent their immune system from rejecting the new liver, and will need regular check-ups with a specialist to make sure the new liver is functioning well and that medication dosages are adjusted appropriately as the child grows.
The transplant team at Mayo Clinic Children's Center works closely with each child's doctor to coordinate care close to home after the recovery period.
“Our nurse coordinators do a great job managing the communication and care between the referring team and the transplant center and making sure everyone is on the same page,” says Dr. Heimbach. “A lot of teamwork is required before and after transplant to ensure each patient has the best outcome.”
For more information
Transplant Center. Mayo Clinic.
Refer the patient to Mayo Clinic.
