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. 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. 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.

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