Some of the first recipients of liver transplants were children.
Although years ago, long-term post-transplant survival was poor, advances in
surgical techniques and anti-rejection medicines have greatly increased the
chances of a successful outcome for this treatment option in children.
What is the liver?
The liver is the body’s largest internal organ, weighing about three pounds
in an adult. It is located below the diaphragm on the right side of the abdomen.
The liver performs many complex functions in the body. A healthy liver:
- Produces most of the proteins the body needs
- Metabolizes, or breaks down, nutrients from food to produce quick energy when needed
- Prevents shortages of nutrients by storing certain vitamins, minerals, and sugar
- Produces bile, which is needed to digest fat and absorb vitamins A, D, E, and K
- Produces most of the substances that regulate blood clotting
- Helps the body fight infection by removing bacteria from the blood
- Removes potentially toxic byproducts of certain medicines
When does a child need a liver transplant?
Liver transplant is considered when the liver ceases to function adequately.
More than half of all pediatric liver transplants are performed in children with
biliary atresia. In this condition, which begins soon after birth, the bile
ducts fail to develop normally and are unable to drain bile from the liver.
Other common causes of liver failure in children include:
- Sudden (acute) failure from infection or certain drugs or poisons
- Long-term (chronic) failure due to:
Chronic hepatitis — This is an ongoing injury to liver cells
that lasts more than six months and includes inflammation. The hepatitis B
and C viruses are its most common infectious causes, but it can be due to an
autoimmune disease (in which the body fights against itself), as well.
Alpha-1-antitrypsin deficiency — The most common genetic cause
of liver disease in children, this hereditary disease can lead to hepatitis
and cirrhosis.
Primary sclerosing cholangitis — This is a disease in which the
bile ducts inside and outside the liver become narrowed due to inflammation
and scarring, causing bile to accumulate in the liver.
Familial cholestasis — This is a condition in which the flow of
bile through any part of the biliary system is interrupted.
Tyrosinemia — This is an inborn error of metabolism caused by an
enzyme deficiency that results in severe liver disease in infancy. Both
parents must be carriers of the gene for the disease to occur.
Wilson’s disease — This is an inherited disorder in which copper
accumulates in the liver, leading to severe liver disease.
- Liver cancer
In advanced liver disease, some or all of the following signs
might begin to appear:
- Jaundice (yellow coloring of the skin and eyes)
- Itching
- Nausea, vomiting, and/or loss of appetite
- Poor weight gain
- Tendency to bruise and bleed easily
- Ascites (fluid in the abdomen)
- Swelling in the legs and feet due to fluid accumulation
- Fatigue and decreased energy
- Clay-colored stools
- Dark, tea-colored urine
- Mental confusion, possibly progressing to coma
- Vomiting blood or passing blood in the stool
The type of liver disease determines which liver functions are
impaired. Your child’s symptoms might be different from other patients
undergoing evaluation for liver transplants.
References
National Digestive Diseases Information Clearinghouse. What I need to know about Liver Transplantation.
digestive.niddk.nih.gov/. Accessed September 15, 2011.
American Liver Foundation. Liver transplant. www.liverfoundation.org/. Accessed September 15, 2011.
American Society of Transplantation. Getting a new liver.
www.a-s-t.org/. Accessed September 15, 2011.
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