Paediatric Liver Transplant Indications

A paediatric liver transplant is a procedure where the non-functioning liver is replaced with a fully functioning liver or a portion of a healthy liver.
This healthy liver is taken from a living or deceased donor.

1. About 1500 to 2000 liver transplants occur in India annually, of which 10% are paediatric transplants.

2. India, with its expert team of doctors and medical facilities, has been highly successful in surpassing a success rate of 90%.

Whether it's an adult or a child, anyone experiencing a life-threatening condition of the liver may require a liver transplant.
Recognising these signs and considering seeking appropriate medical and surgical help is essential.

The following are the primary causes of liver transplantation in children:

1. Biliary Atresia: The most common indication for liver transplantation is biliary atresia.
   It is a chronic condition that damages the liver and causes cirrhosis when the bile ducts are absent or obstructed. 

   When surgical procedures, such as the Kasai operation (surgical treatment for biliary atresia), fail to restore adequate bile flow or when the kid develops end-stage liver disease, paediatric liver transplants for autoimmune liver disease are often considered.

2. Metabolic Disorders: Children with specific inborn metabolic abnormalities may experience increasing liver dysfunction and injury. Examples are:

1. Wilson's Illness: This hereditary ailment leads to copper build-up in the liver and other organs.

2. Alpha-1 Antitrypsin Deficiency: A hereditary condition that results in improper protein synthesis and liver damage.

3. Glycogen Storage Diseases: The ability of the liver to process glycogen is compromised.

4. Maple Syrup Urine Disease: A metabolic condition that affects the metabolism of branched-chain amino acids and causes liver damage.

3. Acute Liver Failure (ALF): The function of the liver is severely weakened in acute liver failure.
   There can be different causes, which include drug toxicity, metabolic disorders, viral infections (like hepatitis), and autoimmune hepatitis. 

   When supportive care is ineffective, and a high risk of death from irreparable liver disease exists, criteria for paediatric liver transplants are a possibility.

4. Chronic Liver Disease: Several chronic liver illnesses can develop in children and proceed to end-stage liver disease, requiring liver transplantation. These comprise the following:

1. Chronic Hepatitis B or C: Viral infections that result in continuous liver damage and inflammation.

2. Alagille Syndrome: A hereditary disease that affects the growth of the bile ducts and harms the liver.

3. Autoimmune Hepatitis: Achronic autoimmune disease can damage the liver, causing inflammation.

4. Progressive Familial Intrahepatic Cholestasis (PFIC): It is a hereditary condition that decreases bile flow, damaging the liver.

5. Cystic Fibrosis: This multisystem disorder can cause progressive liver damage.
   

5. Liver Tumour: Paediatric liver transplant eligibility is crucial for children diagnosed with an incurable or recurrent liver tumour like hepatoblastoma or hepatocellular carcinoma.
   A liver transplant provides the best hope for long-term survival and improved outcomes.

Contraindications like absolute contraindications are medical conditions or situations where a liver transplant cannot be performed under any circumstances.
It can be due to extremely high risks or incompatibility.

These conditions make the person ineligible for a liver transplant, as attempting the procedure could jeopardize their health and well-being.
Below are a few absolute contraindications:

1. Extrahepatic Active Cancer: People with cancer actively spreading outside of the liver, such as cancer in an advanced stage, may be prohibited from receiving a liver transplant.
   After transplantation, there is a substantial chance of cancer recurrence or metastasis, which may outweigh any potential advantages.

2. Advanced Cardiac or Pulmonary Disease: Absolute contraindications may exist for severe cardiac or pulmonary disorders that increase the risk of surgical complications or reduce life expectancy.
   Transplantation might be too dangerous in severe coronary artery disease, severe pulmonary hypertension, or irreversible lung disease.

3. Observable Neurological Impairment: Certain cognitive impairments or impairing neurologic disorders are included in this.
   It can cause severe and irreversible neurological impairment.

Untreated paediatric liver transplant indications can have many adverse effects on the child's overall condition and lead to further damage.
Some of the common consequences of delaying paediatric liver transplant indications include the following:

1. Increased Disease Progression: Delaying a paediatric liver transplant can lead to the progression of the underlying liver condition.
   It can worsen the child's health and potentially complicate the transplant procedure.

2. Reduced Quality of Life: The child may experience a diminished quality of life.
   Liver diseases can cause discomfort, fatigue, and limitations in daily activities.

3. Risk of Complications: As the liver disease progresses, the child becomes more vulnerable to complications such as infections, bleeding, and fluid buildup. This can be life-threatening.

4. Limited Treatment Options: Delaying the transplant may limit the effectiveness of alternative treatments, as liver transplantation is often the best option for certain liver conditions.

5. Organ Availability: Paediatric liver donors are relatively scarce, so delaying the transplant may result in a longer wait for a suitable donor match.

6. Long-term Health Effects: It can impact the child's future health and potential complications.

7. Overall Risk to Life: Ultimately, delaying a liver transplant can increase the risk of life-threatening complications.
   It can reduce the chances of a successful transplant and a healthier life post-transplant.

Preventing the need for paediatric liver transplants is of utmost importance to ensure the well-being of children. 

Focusing on proactive measures and early intervention can reduce the risk of liver diseases and the necessity for transplant procedures. Below are some key points on how to prevent paediatric liver transplant:

1. Vaccinations: Ensuring children receive all recommended vaccinations can protect them from liver infections like Hepatitis A and B.
   This reduces the likelihood of liver disease progression.

2. Healthy Diet: Encouraging a balanced and nutritious diet can help prevent obesity and fatty liver disease in children, promoting optimal liver function.

3. Regular Exercise: Engaging in regular physical activity promotes a healthy weight and overall well-being.
   It reduces the risk of liver-related complications.

4. Hygiene Practices: Promoting good hygiene habits, such as washing hands, can prevent the spreading of infections.

5. Early Detection and Treatment: Regular health check-ups and timely medical intervention can identify liver problems early on, allowing for prompt treatment and minimizing disease progression.

6. Prevention of Mother-to-Child Transmission: Preventing transmission of viral infections from mother to child, such as Hepatitis B, can protect infants from developing liver diseases.

7. Safe Medication Use: Ensuring that children take medications as prescribed and avoiding over-the-counter drug misuse can prevent drug-induced liver damage.

8. Management of Chronic Conditions: Properly managing chronic health conditions like diabetes and autoimmune diseases can reduce their impact on liver health.

A paediatric liver transplant is a safe and successful procedure. However, in some cases, indications of problems may arise.
These problems can be addressed and treated with the help of the following surgical and non-surgical treatments. These are: 

1. Immunosuppressants: These are medicines that are used to control the body's immunity.
   It stops the body's defence from attacking the new liver in the body. 

2. Antibiotics: Medicines are prescribed to patients suffering from problems with infections.
   With the help of antibiotics, one can get rid of bacterial infections and felicitate healing.

3. Interventional Radiology Procedures: These are specialised procedures that regulate blood flow to the new liver.
   This is mostly used in the case of Vascular complications.

4. Endoscopic Retrograde Cholangio-pancreatography (ERCP): Under this procedure, an endoscope is used to treat problems with bile leakage.

Paediatric liver transplantation is a challenging and life-saving treatment for kids with end-stage liver disease, acute liver failure, or certain metabolic diseases. Identifying the proper indications for liver transplantation in paediatric patients can maximise the success rate. 

Contact HexaHealth to explore the most suitable treatment choices for paediatric liver transplants. We'll be there every step, from understanding the condition to providing post-surgical care as your supportive partner.

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