When a liver transplant is necessary, you want your child’s care handled by a team of experts who are well trained and experienced. At UI Children’s Hospital you will find a liver transplant team that’s committed to your child’s care before, during, and well after the surgery.
Our multi-disciplinary pediatric transplant team specializes in the care of children. Their care is delivered in a hospital that is child- and family-centered and is ranked among the nation's best children's hospitals by US News & World Report.
Our pediatric liver transplant program performed its first procedure in 1992 and now ranks among the nation’s best with excellent outcomes for our patients. Specialized pediatric transplant surgeons offer whole organ and split-liver transplants, giving your child the best opportunity for a good outcome.
Why a Transplant?
Transplantation is often the only treatment option for children with end-stage liver disease or acute liver failure, and has a high success rate.
Your child will be carefully evaluated by a multidisciplinary team so that the procedure is tailored precisely to his or her condition.
Our care for your child and your family addresses your concerns. Our pediatricians and surgeons will take the time to explain your child’s condition and the way that a transplanted organ will improve his or her condition. Our specially trained psychologists and social workers will see to it that your child and your family are prepared for making the transition to the new organ and overcoming any barriers to success.
We’ve worked hard to streamline the process for being evaluated and being added to the national transplant waiting list. Our goal is to help our patients get their transplant as quickly as possible. Our record shows that our patients spend fewer months on wait lists than other centers our size.
Preparing for a Transplant
We will work with you to schedule your child for a full day of medical tests, consultations, and educational conferences to determine if transplant is the best option for his or her condition.
Potential liver transplant candidates receive a variety of blood tests and other procedures to provide a clear picture of their health. These precautions—which include tests for heart, lung and kidney function--increase the likelihood of a successful outcome. Blood samples help us assess the function of your child’s body systems, screen for viruses, evidence of cancer, and tissue typing.
Your full day will include meetings with these members of our transplant team:
- Pediatric Transplant Surgeon
- Pediatric Hepatologist
- Clinical Pediatric Psychiatrist
- Pediatric Nutritionist
- Pediatric Dentist
- Pediatric Anesthesiologist
- Transplant Coordinator
- Social Worker
You will meet with a transplant coordinator, who is a registered nurse specializing in organ transplantation. During this meeting, the coordinator will describe all aspects of the transplant process.
You will have ample opportunity to ask questions and discuss your concerns. The transplant coordinator will assist your family through preparation, education, and listing on the donor registry.
A transplant social services representative will meet with your family during the evaluation. The social worker gathers information about coping abilities, support systems, and ability to follow important post-transplant instructions. The social worker provides emotional support and helps you explore appropriate groups and service agencies in your local community.
Approval for Transplantation
When the evaluation is completed, the liver transplant committee will review the results of tests, procedures, and consultations. This committee, which meets weekly, consists of the nurses, pediatricians, surgeons, social workers, and others who you have met throughout the evaluation process. All members contribute their opinion; and a decision is made with regard to further testing, additional treatment, and when your child should be added to the waiting list.
If your child is approved for transplantation, he or she will be placed on the recipient list of the United Network for Organ Sharing (UNOS). Liver recipients are matched to potential donors according to blood type, severity of illness (MELD/PELD score), and waiting time on the list. Depending on your child's age, a specific plan for immunizations prior to transplant will be made after being placed on the waiting list.
The Transplant Stay at UI Children’s Hospital
The following timeline is representative of the typical liver recipient; no two patients will have exactly the same experiences.
Day of Surgery
- Your child will be admitted directly to the pediatric floor under the care of the transplant team.
- The transplant team doctors will examine your child and talk to you about any changes in your child's condition since the last visit and to answer any questions you might have.
- Blood samples will be obtained.
- A chest x-ray and EKG will be obtained.
- An enema will be given to cleanse the bowel.
- Your child will go to surgery within hours of being admitted.
- The transplant operation usually lasts 4-6 hours but your child will be in the operating room for several extra hours prepping for surgery and for transfer back to the ICU.
- The OR team will call over to the waiting room periodically to give you updates during the operation.
- The surgeon will meet with you directly once the operation is complete.
- Your child will go directly to the Pediatric Surgical Intensive Care Unit after surgery and the breathing tube will be taken out when your child is awake enough and able to breathe well enough without the tube.
First Post-Operative Day
- Your child will have several drains in place from surgery. These drains monitor for bleeding or fluid collecting. They usually come out over the first few days after surgery.
- Your child may not be eating or drinking until his or her bowel wakes up from the anesthesia, although he or she will begin taking medications with a few sips of water.
- Your child will have an IV to prevent dehydration and to administer some medications.
- Your child will have a bladder catheter in place to drain urine. This catheter usually remains in place for at least two days to allow the bladder to empty while on pain medications, and so that urine output can be closely monitored.
- Your child will have vital signs monitored hourly in the immediate post-operative period.
- Your child will have blood drawn once a day.
- Your child will be assisted in moving around and potentially taking a first walk (if appropriate) within 12 hours after surgery. Nurses and therapists will work every day to encourage increasing amounts of activity to prevent complications such as pneumonia and blood clots.
- Your child will be encouraged to cough and deep breathe to prevent pneumonia.
Second Post-Operative Day to Discharge (usually after 7 to 14 days)
- Your child will probably begin drinking clear liquids at mealtimes by Post-Op Day 2, and may even be eating age-appropriate solid foods if they are tolerated.
- You and your child will be taught about the new medications, and signs and symptoms of both organ rejection and infection.
- A pediatric transplant coordinator nurse will speak with you to arrange for local laboratory blood work and further follow-up.
- Your child will have a first follow-up appointment at the Pediatric Specialty Clinic approximately one week after discharge. You will be given the date and time of this appointment before your child is discharged.
- Most children's wounds are closed with sutures under the skin. These stitches dissolve and do not have to be removed. If for some reason your child has a stapled closure, the staples are removed three weeks after the transplant.
After Your Child’s Transplant
For the first six months after surgery your child’s health will be monitored closely by the transplant doctors and transplant coordinator.
Because of the frequency of check ups during this time, you and your child will need to be prepared to travel to Iowa City frequently or to stay nearby for the first three months.
Throughout his or her life, your child’s check ups will include blood tests to monitor liver function, kidney function, and immunosuppression drug levels. The frequency of the lab tests will spread out from daily during the hospital stay to every two to three months at one year after the transplant.
Your child’s pediatric specialist may recommend biopsies of liver tissue, especially duringthe first year, to check for rejection of the new liver. These biopsies will be less frequent in future years.
Your child will take drugs for the rest of his or her life to prevent the body from rejecting the transplanted liver.
Most children feel close to normal two to three months after surgery, but complete recovery from a liver transplant can take up to six months. Your child’s pediatric specialist will advise you on when your child can return to normal activities based on your child’s health.