June 20, 2024
Liver disease affects children of all ages and has many adverse effects. Children needing liver transplants can face many unique challenges and can benefit from Mayo Clinic's multidisciplinary expertise and extensive experience in both pediatric and adult liver transplantation.
There are many reasons why a child might need a liver transplant. The primary indications for liver transplant include:
- Biliary atresia — A condition in infants in which the bile ducts outside and inside the liver are scarred and blocked.
- Genetic disease.
- Cancer.
- Acute liver failure.
"It's so important that these children have a team that knows these conditions well," says Samar H. Ibrahim, M.B., Ch.B., medical director of the pediatric liver transplant program within the Transplant Center at Mayo Clinic in Rochester, Minnesota. "It's important to have the tools to diagnose quickly and also have the experience and expertise to have a good outcome."
At Mayo Clinic Children's Center, a multidisciplinary team of specialists cares for children with liver disorders. The team includes pediatric gastroenterologists, pediatric hepatologists, pediatric registered nurses, physician assistants, pediatric dietitians, psychologists, radiologists, and transplant and general surgeons. Other experts in pediatric subspecialties, such as renal and heart and endocrine diseases, also are involved. Mayo Clinic Children's Center offers state-of-the-art diagnostic and interventional studies such as:
- Noninvasive hand-held devices to measure hepatic fibrosis.
- Magnetic resonance cholangiopancreatography (MRCP), which is a noninvasive procedure to evaluate the bile ducts of the liver.
- Magnetic resonance elastography, which estimates liver stiffness and scar tissue formation, and other imaging techniques for vascular, biliary and tissue imaging.
- Therapeutic minimally invasive procedures by complex endoscopy specialists and interventional radiologists.
Mayo Clinic also offers access to innovative laboratory testing. "We have the capacity to perform ultrarapid, whole-genome sequencing," says Dr. Ibrahim. "This can be especially helpful in patients with acute liver failure in the neonatal period, for example," explains Dr. Ibrahim.
Living-donor liver transplant
The number of children waiting for liver transplants exceeds the number of available livers from deceased donors. Living-donor liver transplant offers an alternative to waiting for a deceased-donor liver. With a living-donor transplant, a transplant recipient may receive a new liver more quickly and avoid some health complications associated with the longer wait time for a deceased-donor liver.
"When considered from the time a patient is placed on the transplant waitlist, patients who have a living-donor liver transplant have superior outcomes," says Julie K. Heimbach, M.D., a transplant surgeon and the director of the Transplant Center at Mayo Clinic in Rochester, Minnesota.
Living-donor liver transplants were first performed in children, and they remain more common among children who need liver transplants than among adults.
"For liver transplant in children, the anatomy of the recipient and donor are especially important," explains Dr. Heimbach. "Importantly, in most cases, adults who are donating to a pediatric recipient can donate a smaller part of their liver. For the donor, the liver typically fully regenerates in about 6 to 8 weeks."
Outcomes following liver transplantation for children are excellent, but children with new livers will need immunosuppression medications for the rest of their lives to help prevent their immune systems from rejecting a new liver. They'll also need regular visits with specialists to make sure the new liver is working well and that the dose of medications is adjusted properly as the child grows.
The Mayo Clinic Children's Center transplant team works closely with each child's primary care doctor to coordinate care close to home once they've completed the recovery period.
"Our nurse coordinators do a tremendous job of managing the communication and care between the referring teams and our transplant center to ensure everyone is on the same page," says Dr. Heimbach. "It takes a lot of teamwork pre- and post-transplant to ensure that each patient has the best outcome."
For more information
Transplant Center. Mayo Clinic.
Refer a patient to Mayo Clinic.