Before transplant surgery

If your child is on a waiting list, the transplant coordinator will call you when a donor liver is found. When you arrive at the transplant center or hospital, your child’s health will be checked.

The surgery may be postponed if your child has a current or recent illness, changes in liver health, or if there are problems with the new liver. This can be frustrating. Remember that the best decision is made for your child’s health. Once surgery is scheduled:

• Prepare your child for the transplant as you have been instructed.

• Start to give anti-rejection medicine (see below) as prescribed.

• Call the transplant center if your child gets a cold or other illness during the prep time. This can affect whether the transplant can be done.

During transplant surgery

A liver transplant can take  3 to 12 hours. Your child will be given general anesthesia. This prevents pain and makes your child sleep through surgery. The child’s sick liver is removed from the body. The new healthy donor liver is put in. Blood vessels and bile ducts are then attached to the new liver.

After surgery

Your child will stay in the hospital for about 7 to 10 days or longer. For a time after surgery, your child will recover in the intensive care unit (ICU). In the ICU, your child will be on a machine to help them breathe (ventilator). Nurses and other healthcare providers will closely watch your child’s health and liver function. Tests will be done to check that the new liver is working well. These may include ultrasound tests, a liver biopsy, and blood tests.

In the weeks and months after surgery, your child will need to be closely watched for signs of a problem. Possible problems include:

• Organ rejection (see below)

• Infection

• Complications from surgery

• Side effects from medicines

What is organ rejection?

The body's immune system fights germs. It also protects against foreign things that may cause the body harm. When an organ is transplanted, your child’s immune system sees the new organ as a foreign material. It starts to fight the new organ. This is called organ rejection.

Your child will need to take antirejection medicine. It prevents the immune system from fighting the organ. Your child will take these medicines for the rest of their life. Talk to your child’s healthcare provider about the benefits and risks of this medicine. Make sure that all your child’s other healthcare providers know they take this medicine.

What are the long-term concerns?

After recovery, most children may live normal lives. These are things to be aware of:

• Your child will have to take antirejection medicine for the rest of their life. This is to prevent rejection of the new liver. This medicine suppresses their immune system. It makes it weaker in fighting illness. This means they will need to see a healthcare provider right away even with a mild illness.

• In some cases, the child’s spleen may remain enlarged after surgery. An enlarged spleen means your child will need to not do contact sports. Their provider will advise you.

• If your child has a disease that attacked the old liver, the disease can return in the new liver. Your child’s provider will tell you more.

When to call the healthcare provider

Contact your healthcare provider right away if your child has any of the below:

• Fever of 100.4°F ( 38°C) or higher, or as advised

• Chills

• Vomiting or diarrhea for  24 hours or longer

• Signs of dehydration, such as less pee, very dark pee, dry mouth, and no tears when crying

• Swelling in the hands, arms, feet, ankles, abdomen, or face

• Bleeding from the nose, mouth, or rectum

• Bloody stools

• Bruising that occurs more easily than normal

• Bleeding, redness, or fluid leaking from incisions

• Low energy

• Sudden weight gain of more than 2 pounds in 24 hours

• Flu-like symptoms, such as body aches or chills

• Cough with sputum

• Yellowing of eyes or skin

• Rash

Call 911

Call 911 if your child loses consciousness.