Liver Transplant

What is a liver transplant?

A liver transplant is an operation performed to replace a diseased liver with a healthy liver or a segment of a healthy liver. In some cases, it’s done in combination with other organ transplants, such as intestines or kidneys. The liver may come from a deceased donor or from what’s called a “living donor,” a family member or an individual who is willing to donate and is a suitable candidate.

A transplant offers a chance for independence and better quality of life. Frequent medical supervision is still necessary after a transplant, but this need does decrease over time. It is critical to understand that a transplant is a treatment, not a cure. Potential transplant recipients must be committed to transplantation as a form of treatment in order to manage the complexities of life post-transplant.

Options for liver transplant candidates

Living-donor liver transplants

Several transplant centers around the world have developed the technique of living-donor liver transplantation, which has been very successful in children. Current data suggests that the results of living-donor liver transplants are at least similar to, and perhaps better than, deceased donor liver transplantation.

The basis for taking a part of a living person’s liver lies in the organ’s unique ability to grow back (regenerate) to its normal size. A part of the liver (a lobe) can be removed without causing any damage in liver function.

The operation on the donor to obtain a piece of their liver and the operation on the recipient to transplant the liver, are performed simultaneously, and the donor can expect to be in the hospital for approximately one week. Within one to two months, both the liver of the donor and the portion in the recipient regenerate to normal size.

The decision to pursue a living-donor transplant requires thoughtful consideration. At Boston Children’s Pediatric Transplant Center, this procedure is done in collaboration with Lahey Clinic. The adult donor undergoes an extensive evaluation at Lahey Clinic, and the surgery on the donor is performed at Lahey.

Deceased-donor liver transplants

In most cases, the healthy liver will come from an organ donor who has just died. Either a whole liver may be transplanted, or a part of one.

While a liver transplant is the preferred treatment for many people with liver disease, there are not enough deceased donor livers to meet the needs of all potential recipients. Split-liver transplants involve dividing a deceased donor’s liver so two recipients (one small child and one adolescent or adult) may benefit from one liver donation.

A reduced-liver transplant is when a piece of a deceased donor liver is used for a smaller patient.

The liver’s unique ability to grow back to its normal size makes both split-liver and reduced-liver transplants possible.

Why is a liver transplant recommended?

The liver is the largest solid organ in the body. It is located in the upper right portion of the abdomen, near the stomach. The liver is divided into eight segments, making the lobes. It receives blood from two sources: the portal vein and the hepatic artery. The portal vein brings nutrients to the liver from the intestine, and the hepatic artery brings oxygen to the liver from the heart and lungs.

All in all, the liver performs more than 400 different functions that keep a person healthy including:

  • production of bile that allows the body to use protein, fat and carbohydrates
  • production of blood-clotting substances
  • use and storage of minerals and vitamins
  • detoxification of many substances including drugs and alcohol

The liver may fail to function properly for multiple reasons. The most common reason for liver failure in children is biliary atresia. Other conditions include:

Liver transplantation is an option for individuals who are no longer responding to treatment or for those with advanced liver disease.

Evaluation for transplant

An evaluation is necessary to determine the risks and benefits of a transplant, identify potential problems, discuss the options of a living donor vs. deceased donor and identify the risks and benefits for potential donors.

If a child is being evaluated for a transplant, they will see a number of health care professionals from the Pediatric Transplant Center. The evaluation usually takes place as an outpatient, during which time the child undergoes a number of tests. These may include:

  • blood tests
    • blood type (a donor and recipient must have compatible blood)
    • liver and kidney function
    • tests to check for exposure to viruses, bacteria and infections, such as Hepatitis A, B and C; HIV; Cytomegalovirus; Epstein Barr Virus and Herpes simplex virus
  • an abdominal ultrasound or CT scan which allows physicians to see the liver and flow of blood through arteries and veins
  • a chest x-ray to see if the child’s lungs are healthy
  • tuberculosis testing, if not completed by a pediatrician

After these consultations and tests are complete, our liver transplant team meets as a group to determine whether the child is a good candidate for a liver transplant and to determine the best time for the child to be placed on the transplant waiting list. If he or she is a transplant candidate, we make sure the family is fully educated about the risks and benefits, and the child will be placed on the United Network for Organ Sharing waiting list, or in the case of a living donor, the transplant will be scheduled.