Paediatric Liver Transplant Guidelines

Medically Reviewed by Dr. Aman Priya Khanna
Written by Sangeeta Sharma, last updated on 3 February 2024
Paediatric Liver Transplant Guidelines

With children facing life-threatening liver conditions, paediatric liver transplant guidelines aim at providing the best care possible. These guidelines represent a comprehensive set of recommendations and protocols crafted by leading medical experts.

Their primary objective is to outline the best practices for evaluating potential candidates, performing the transplant procedure, and ensuring post-operative care. 

By adhering to these guidelines, medical professionals aim to maximise the success rate of liver transplants in children, granting them a chance at a healthier, happier future.

About Paediatric Liver Transplant

Paediatric liver transplants are a lifesaver for children suffering from liver-related ailments. Under this procedure, the damaged liver of a child is replaced with a healthy one. This is from either a deceased or a living donor. 

Below are the guidelines for paediatric liver transplants.

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Paediatric Liver Transplant Guidelines

A multidisciplinary team of healthcare experts, including paediatric hepatologists, transplant surgeons, nurses, and other specialists, conducts the evaluation. The team thoroughly evaluates the child's overall health, liver condition, and medical history.  Following are the steps of the guidelines in details:


The evaluation of the paediatric liver transplant screening procedure is an essential step to determine if children with severe liver disorders might benefit from and need a liver transplant. 

  1. Medical Evaluation: Comprehensive medical history, including liver disease progression and previous treatments. Physical examination to assess overall health and liver-specific symptoms. Tests in the laboratory to evaluate liver function, blood coagulation, and overall health status

  2. Psychological and social evaluations: Emotional well-being and coping capacities of the youngster are assessed. The family's awareness of the transplant process and commitment to post-transplant care are assessed. Evaluation of social support to ensure a stable and supportive environment for the child's recovery.

  3. Imaging Diagnostics: Ultrasound, CT scan, or MRI imaging examinations are used to check the anatomy of the liver and any associated issues.

  4. List of Liver Transplants: Based on the evaluation results, the kid may be placed on the national transplant waiting list, which is prioritised based on the severity of the ailment.

Listing for Transplant 

Children who could require a paediatric liver transplant criteria suffer from the following symptoms. Thorough evaluations, medical assessments, and ranking based on urgency and suitability are all part of the listing process. The following factors influence a patient's position on the waiting list.

  1. Criteria for Suitability: Patients must meet strict criteria to be listed at transplant facilities. These criteria consider aspects such as the severity of organ failure, the patient's overall health, and the possible benefits of transplantation.

  2. Organ Priority and Allocation: National or regional transplant networks oversee the allocation of organs. These networks employ algorithms to connect accessible organs with possible receivers based on various characteristics such as medical urgency, compatibility, and waiting time.

  3. Option for Living Donor Transplant: Living donation is an option for specific organs, such as kidneys and liver components. A healthy person donates an organ or a portion of an organ to a recipient through living donor transplantation. Living donors are evaluated to ensure compatibility as well as the donor's health and safety.

  4. Waiting Period: The length of the transplant wait depends on factors such as organ availability and the severity of the patient's illness. Some patients may be given transplants immediately, while others may have to wait months or years.

Preoperative Management 

Healthcare experts have decided on certain guidelines and evaluations to streamline paediatric liver transplant surgery. The pre-operative paediatric liver transplant guidelines include the following: 

  1. Confirmation of indication transplantation.

  2. Determining disease severity.

  3. Analysing alternative treatments to transplantation.

  4. Identifying active infections and immunological status of the child.

  5. Establishing pre-therapeutic plans

  6. Detailed discussions with the parents and the child, if possible.

  7. Discussing and understanding the financial status and financial aid for the transplantation.

Organ Allocation 

A paediatric liver transplant selection is a significant choice that must be carefully considered. Organ allocation is a life-saving therapy option for those with end-stage organ failure.

  1. Medical Urgency: The severity of a patient's condition is the most important factor. Those with the most urgent medical needs are prioritised on the waiting list. This strategy tries to ensure that organs are distributed to people in desperate need of transplantation.

  2. Time on the Waiting List: The amount of time a patient has been on the waiting list is a consideration in deciding their priority in some organ allocation systems.

  3. Compatibility: In the case of organs such as kidneys, compatibility between donor and recipient is critical to preventing organ rejection. In kidney transplantation, HLA typing and blood type matching are critical aspects.

  4. Geographical Considerations: Some allocation systems use geographic location to save organ transit time and optimise viability.

  5. Ethical Considerations: Organ allocation methods must follow ethical norms such as not discriminating against people based on their age, race, gender, or socioeconomic standing. Transparency, fairness, and informed consent are critical in the allocation process.

Procedure of Paediatric Liver Transplant

The procedure for organ allocation includes numerous key steps and considerations. It guarantees that donated organs are matched with prospective receivers fairly and efficiently. The procedure involves: 

  1. Once a suitable donor has been found, the patient and the team of doctors meet at the hospital to run final tests. These tests are a must to ensure the patient's credibility for the organ transplant. 

  2. After the credibility of the patient has been verified through the essential tests, it's time to move the patient to the OT. Here the patients are given general anaesthesia and put to sleep. An incision is made across the abdomen. 

  3. The blood vessels of the damaged liver are cut and removed from the body.

  4. After the damaged organ has been successfully removed, it is replaced by a new organ.

  5. Bile ducts and blood vessels are reattached to the new liver to ensure proper blood supply and function.

  6. The incision is then stitched up or stapled.

  7. After the transplant, the patients are moved to intensive care units.

Post Operative Management

Following post-operative paediatric liver guidelines is essential to ensure the child's long-term life expectancy and complete recovery. The post-operative guidelines include the following: 

  1. Staying in the Intensive Care Unit for strict monitoring and detection of problems

  2. Staying in the hospital after being released from the ICU 

  3. Proper medications and dietary intake based on the doctor's recommendation

  4. Following other safety procedures advised by the doctors 

Paediatric Liver Transplant Complications

There are certain risks and complications associated with the paediatric liver transplant. Before a person moves ahead with the surgery stage, they must be aware of the risks involved. 

  1. Vascular Complications: Conditions such as hepatic artery thrombosis can arise where there is a problem with the blood vessels supplying blood to the transplanted liver.

  2. Biliary Complications: These complications are related to the bile ducts. There can be cases of bile narrowing, leaks, or obstruction of the bile ducts.

  3. Parenchymal Complications: These are complications related directly to the tissues of the transplanted organ. Parenchymal complications can cause: 

    1. Organ Rejection 

    2. Graft Dysfunction

    3. Hepatitis 

  4. Extra-Parenchymal Complications: These complications occur not in the transplanted liver but around the transplanted liver. This includes the blood vessels and other nearby structures. 

When to See a Doctor

Seeking medical assistance from a doctor is important in various scenarios, whether you are suffering from health problems or wish to focus on preventive care. 

1. Symptoms that are persistent or severe: If you have chronic or severe symptoms, such as high fever, uncontrollable pain, a prolonged cough, or sudden and severe headaches, you should see a doctor. These symptoms could be the result of underlying health issues that demand prompt attention.

2. Injuries or mishaps: Seek medical assistance right away if you are injured or in an accident, especially if you have shattered bones, brain injuries, or serious cuts that require stitches. Injuries might become more complicated if treatment is delayed.

3. Chronic Health Issues: If you have a chronic health condition such as diabetes, asthma, hypertension, or any other persistent medical issue, you must see a doctor on a frequent basis to check your health and successfully manage the disease.


By following the guidelines, paediatric liver transplant patients receive standardised, superior care, improved treatment outcomes and general well-being. Guidelines play a crucial role in the management and allocation of the liver transplant procedure, becoming a lifeline for many. 

HexaHealth is one of the leading health and wellness platforms that is always available to answer your questions or concerns regarding medicine and health. Our team of HexaHealth experts is here to assist you and connect you with the appropriate doctors who can provide the necessary treatment and guidance.

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Frequently Asked Questions

What are the paediatric liver transplant guideline?

The criteria, assessment method, and treatment protocols for carrying out liver transplants in children are outlined in a collection of suggestions and standards known as paediatric liver transplant guidelines.

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What are the specific guidelines for child liver transplant surgeries?

Yes, specific child liver transplant guidelines have been devised to assure the procedure's safety and effectiveness.

  1. The choice of the patient

  2. Pre-transplant assessment

  3. Surgical methods

  4. Immunosuppressive regimens

  5. Post-transplant care

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What criteria determine the eligibility for a paediatric liver transplant?

Paediatric liver transplant eligibility is determined based on several factors, including : 

  1. The severity of liver disease

  2. The child's overall health

  3. Ability to tolerate the procedure

  4. The potential benefits of transplantation compared to other treatment options. 

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What is involved in the evaluation process for pediatric liver transplant candidates?

The evaluation process for pediatric liver transplant candidates involves a comprehensive assessment of the following:

  1. Child's medical history

  2. Physical condition

  3. Liver function 

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How is the selection of paediatric liver transplant recipients carried out?

Paediatric liver transplant selection candidates are subjected to a thorough review of their physical characteristics, medical history, and liver function.

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What are the pre-operative guidelines for paediatric liver transplant surgeries?

Practices followed before surgery comprise the pre-operative guidelines for paediatric liver transplant protocols. 

  1. To guarantee the greatest outcome

  2. Patient assessment

  3. Surgical planning

  4. Handling liver disease complications

  5. Optimising the child's general health

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What are the postoperative guidelines for paediatric liver transplant patients?

In order to ensure the best possible recovery and long-term success, paediatric liver transplant patients must adhere to a set of recommendations and protocols after the operation.  

  1. Managing immunosuppression,

  2. Monitoring graft function, 

  3. Preventing infections, 

  4. Providing follow-up treatment

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What are the recommended follow-up guidelines for paediatric liver transplant patients?

The suggested follow-up guidelines for paediatric liver transplant patients are a series of recommendations describing post-transplant treatment. These include : 

  1. Regular clinic visits

  2. Lab testing, 

  3. Imaging investigations,

  4. Medication adjustments,

  5. Monitoring for problems 

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What are the medication guidelines for paediatric liver transplant recipients?

Medication guidelines for paediatric liver transplant patients are a set of rules and recommendations that describe how to take drugs after the transplant and how much to take. These recommendations emphasise the use of: 

  1. Immunosuppressive medications

  2. Anti-infective drugs,

  3. Preventative therapies, 

  4. Medications are required to sustain graft function and avoid problems.

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What guidelines are followed for evaluating potential liver donors for children?

To ensure the safety and suitability of the donor, a set of rules is followed while examining possible liver donors for children. These recommendations cover extensive medical and psychiatric evaluations, compatibility tests, etc.

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How are paediatric liver transplant recipients managed according to guidelines?

To ensure their welfare and the long-term success of the transplant, paediatric liver transplant recipients are monitored in accordance with specified standards. These recommendations address a variety of topics, such as : 

  1. Immunosuppression

  2. Monitoring graft function

  3. Preventing infections

  4. Scheduling frequent follow-up appointments

  5. Providing emotional support

  6. Providing information on post-transplant care

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What are the infection control guidelines for paediatric liver transplant procedures?

The advice and methods in the infection control guidelines for paediatric liver transplant procedures are targeted at preventing and controlling infections before, during, and after the transplant. These include : 

  1. Preventative measures against bacterial

  2. Viral and fungal illnesses

  3. Early identification and fast treatment

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What guidelines are for managing rejection in paediatric liver transplant recipients?

The recommendations and strategies for detecting, avoiding, and treating rejection episodes are included in the guidelines for treating rejection in paediatric liver transplant recipients. These include : 

  1. Graft function monitoring

  2. Immunosuppressive control 

  3. Early graft loss prevention action

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What are the anaesthesia guidelines for paediatric liver transplant surgeries?

The recommendations and protocols for the safe and successful administration of anaesthesia during the surgical process are included in the anaesthesia guidelines for paediatric liver transplant surgeries.

  1.  Pre-operative evaluation

  2. Anaesthetic induction maintenance

  3. Hemodynamic management

  4. Pain management

  5. Postoperative care

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What guidelines are followed by the surgical team during paediatric liver transplant procedures?

The surgical team follows a set of comprehensive guidelines to ensure the safety and success of the pediatric liver transplant procedure, which may include:

  1. Meticulous pre-operative evaluations and medical assessments.

  2. Coordination with a multidisciplinary transplant team, including pediatric hepatologists, surgeons, anesthesiologists, and transplant coordinators.

  3. Communication with the child's family to provide information, address concerns, and obtain informed consent.

  4. Selection of an appropriate donor liver (deceased or living) based on size compatibility and medical suitability.

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Are there specific ethical guidelines related to paediatric liver transplant procedures?

To ensure a safe and successful treatment, the surgical team adheres to a set of rules while doing paediatric transplants. These recommendations address several topics, such as

  1.  Pre-operative planning

  2.  Surgical technique

  3.  Organ preservation

  4.  Vascular and biliary reconstruction

  5.  Postoperative care

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What are the guidelines for conducting psychosocial assessments for paediatric liver transplant candidates?

Paediatric liver transplant candidates must have psychosocial evaluations to determine the following:

  1. Psychological and social health

  2. Psychosocial aspects

  3. Mental health issues 

  4. Family dynamics

  5. Support networks

  6. Post-transplant treatment

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How do multidisciplinary teams follow guidelines in paediatric liver transplant procedures?

To guarantee thorough and coordinated treatment, multidisciplinary teams are necessary for juvenile liver transplant surgeries. They are made up of medical experts from diverse specialities who work together to address each patient's particular needs and improve outcomes.

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What are the guidelines for long-term care after a paediatric liver transplant?

After a paediatric liver transplant, long-term care is essential to maintain the recipient's health and well-being. It entails keeping an eye on the

  1. Transplant's success, controlling potential side effects

  2. Supporting the child's physical

  3. Emotional and developmental needs

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What are the nutrition guidelines for paediatric liver transplant recipients?

Their diet significantly influences paediatric liver transplant recipients' overall health and recovery. The guidelines include : 

  1. Eating small and frequent meals

  2. Consumption of high-protein and high-calorie food such as lean meat, cottage cheese, peanut butter, nuts, etc

  3. Supplements to meet the nutrient intake

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What are the guidelines for the discharge process after a paediatric liver transplant?

Following a juvenile liver transplant, the transition from the hospital to home care must be carefully managed. Adhering to instructions promotes seamless and secure growth, optimum healing, and continued care for the kid. These include : 

  1. Strict monitoring 

  2. Frequent assessments 

  3. Detection of complications 

  4. Timely diagnosis and treatment 

  5. Self-care 

  6. Regular doctor check-ups

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Are there specific guidelines for paediatric liver transplant centres?

Paediatric liver transplant centres are specialist hospitals that offer excellent care to kids who need liver transplants. The specific guidelines for these centres include : 

  1. A high standard of hygiene and cleanliness should be maintained 

  2. A proficient and skilled team of doctors 

  3. The use of advanced tools and equipment 

  4. Equal treatment for all patients 

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What are the guidelines for ensuring quality assurance in paediatric liver transplant procedures?

To receive standardised, secure, and efficient care, quality assurance guidelines are essential for paediatric liver transplant patients. These guidelines include : 

  1. Comprehensive management approach 

  2. Avoiding adverse drug interactions 

  3. Educating parents regarding safety considerations.

  4. Timely recognition of post-transplant and rejection-related complications 

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All the articles on HexaHealth are supported by verified medically-recognized sources such as; peer-reviewed academic research papers, research institutions, and medical journals. Our medical reviewers also check references of the articles to prioritize accuracy and relevance. Refer to our detailed editorial policy for more information.

  1. Pediatric Liver Transplants [Internet]. Yale Medicine. link
  2. Horvat N, Marcelino ASZ, Horvat JV, Yamanari TR, Batista Araújo-Filho J de A, Panizza P, et al. Pediatric Liver Transplant: Techniques and Complications. RadioGraphics. 2017 Oct;37(6):1612–
  3. Evaluation of the Pediatric Liver Transplant Patient | AASLD [Internet]. [cited 2023 Jul 29].link
  4. Mayo Clinic. Liver transplant - Mayo Clinic [Internet].
  5. Grimaldi C, Spada M, Maggiore G. Liver Transplantation in Children: An Overview of Organ Allocation and Surgical Management. Current Pediatric Reviews. 2021 Nov;17(4):245–
  6. Bellini MI, Lauro A, D’Andrea V, Marino IR. Pediatric Liver Transplantation: Long-Term Follow-Up Issues. Experimental and Clinical Transplantation. 2022 May;20(Suppl 3):27–

Updated on : 3 February 2024


Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More


Sangeeta Sharma

Sangeeta Sharma

BSc. Biochemistry I MSc. Biochemistry (Oxford College Bangalore)

6 Years Experience

She has extensive experience in content and regulatory writing with reputed organisations like Sun Pharmaceuticals and Innodata. Skilled in SEO and passionate about creating informative and engaging medical conten...View More

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