Why Give? - Liver Transplantation in Children
What is liver transplantation?
Liver transplantation is an operation performed to
replace a diseased liver with a healthy one from another person.
An entire liver or just a section may be transplanted. The
liver may come from an organ donor or from a family member
who is willing to donate a part of his or her liver and is
a suitable candidate to donate. Many children and adults have
had liver transplants in Canada and across the world and now
lead normal lives. Every year approximately 40 to 50 children
under the age of 18 years will receive a liver transplantation
in Canada. The Hospital for Sick Children in Toronto, Canada,
has been performing liver transplantation in infants and children
since 1986, with over 350 liver transplants performed in children
from across Canada to-date.
When is liver transplantation recommended?
A liver transplant is the only hope for survival
of patients with advanced liver disease and for those with
acute liver failure. There are no other options available for
a failing liver as there are for patients with other failed
organs. For example, dialysis (a method of cleansing the blood)
can be carried out for long periods of time for patients with
kidney failure. Unfortunately, this kind of technology is not
available today for patients with liver failure because many
functions of the liver cannot be matched.
Why do children need liver transplantation?
The
2 most common conditions in children for which
liver transplants are done are biliary atresia
and acute liver failure. In biliary atresia,
bile ducts (which are tubes that
carry bile out of the liver) are missing or damaged,
and the resultant obstruction of bile flow then
causes cirrhosis in
infants. In acute liver failure, a previously
healthy child suddenly (acutely) develops serious
liver dysfunction, and
the specific reason is often not identifiable
despite
complete and extensive investigations by experienced
teams. A multi-national,
multi-center collaborative research consortium
called Pediatric Acute Liver Failure (PALF) study
group recently confirmed that
in over 50% of cases of pediatric acute liver
failure, the specific cause is unidentifiable or “indeterminate”. A
liver
transplant is recommended for such children with
serious liver dysfunction and who will not be able to live
without having
his or her liver replaced.
What are the signs of liver problems?
Signs of liver problems include yellowness of the
skin and the whites of the eyes (a condition called
jaundice), severe itchiness, feeling tired or weak, bloating
of the abdomen
due to fluid build-up (a condition called ascites),
bruising or bleeding easily (such as nosebleeds), losing weight,
appetite
loss, and change in mental function or excessive
fatigue/sleepiness compared to what is normal for the patient.
How old does a child have to be to be able to have
a liver transplantation?
Because biliary atresia is the commonest reason
for a child to receive a liver transplant, the
average age of a child
at time of liver transplant is young at approximately
18 months. However, liver transplants have been
performed in infants as
small as 2.5 kg.
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