Paediatric Liver Transplant - Guidelines, Age, Life Expectancy

Paediatric Liver Transplant

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Paediatric Liver Transplant

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A paediatric liver transplant involves replacing a diseased or malfunctioning liver in children with a healthy liver. In 2022, there were over 1,500 Paediatric liver transplants performed in India. This procedure has transformed the lives of countless children worldwide, offering them a chance at a healthy future.

Continue reading to know all about the paediatric liver transplant guidelines, minimum age requirements, and child's liver transplant life expectancy associated.

Procedure Name Paediatric liver transplant
Disease Treated Biliary atresia, acute liver failure, metabolic liver diseases, liver tumours
Benefits of the Surgery Improved quality of life, prolonged survival, resolution of underlying liver disease
Treated by Hepatologist and gastrointestinal surgeon

What is Paediatric Liver Transplant?

A paediatric liver transplant (PLT) is a life-saving procedure that involves replacing a damaged or failing liver in kids with a healthy liver from a deceased or living donor. The liver only takes 6 - 8 weeks to grow back to its normal size.

This surgical intervention offers hope and a chance at a healthier life for children suffering from severe liver diseases like biliary atresia (BA) etc.

What is Liver Transplant

Types of liver transplant

There are two main types of paediatric liver transplant procedures: deceased and living donor liver transplants.

Deceased Donor Liver Transplant:

In this type of transplant, the liver is procured from a deceased donor who has previously consented to organ donation. There are two subtypes of deceased donor liver transplant :

  1. Whole Liver Transplant: In this procedure, the entire liver from a deceased donor is transplanted into the child. This type of transplant is suitable for children who require a full liver due to the extent of their liver disease or when a partial liver transplant is unavailable.
  2. Split Liver Transplant: In certain cases, a deceased donor's liver can be divided into two portions, with one portion transplanted into an adult recipient and the other portion into a paediatric recipient. A split liver transplant allows one donor liver to save two lives potentially.

Living Donor Liver Transplant:

Living donor liver transplant involves the transplantation of a portion of a healthy liver from a living donor, typically a family member, to a child in need. There are two subtypes of living donor liver transplants:

  1. Living Related Donor Transplant: In this procedure, a liver lobe or segment is surgically removed from a healthy adult donor, usually a parent or close relative, and transplanted into the child. The remaining portion of the donor's liver regenerates over time.
  2. Living Unrelated Donor Transplant: In rare cases, a living donor who is not a blood relative of the child may donate a portion of their liver for transplantation. This type of transplant requires a thorough evaluation of the donor to ensure compatibility and safety.

Types of Donor for Liver Transplant Image

Anatomy and Physiology of the Hepatobiliary System

The Hepatobiliary (HPB) system produces, stores, and transports bile. The HPB mainly comprises the liver, gallbladder and bile ducts.

  1. The liver is the largest gland of the human body. It synthesises bile, which is associated with the digestive action.
  2. The gallbladder stores and concentrates the fluid produced through the hepatic system. 
  3. Bile ducts transport bile between the liver and gallbladder to the small intestine for fat digestion. 

Understanding Hepatobiliary System Image

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When is Liver Transplant Required in Kids?

A paediatric liver transplant is considered when a child's liver is no longer functioning adequately, and other treatment options have been exhausted. Here are some situations where a paediatric liver transplant may be necessary:

End-Stage Liver Disease:

Children who have reached an advanced stage of liver disease, where the liver can no longer perform its essential functions adequately, may require a transplant. End-stage liver diseases include.

Biliary Atresia:

This condition involves the blockage or absence of bile ducts, leading to bile accumulation and progressive liver damage.

  1. The Kasai procedure (hepatoportoenterostomy) is the first line of treatment for BA. It doesn't cure the condition. However, when performed early, it slows liver damage and potentially delays or avoids liver transplant. It is one of the progressive liver diseases. If portoenterostomy surgery is unsuccessful, the survival is not beyond 36 months of life.
  2. With a liver transplant, the expected survival rates for these patients are: 90.0% at one year and 87.2% at five years.

Alagille Syndrome:

A genetic disorder that affects various organs, including the liver, causing bile duct abnormalities and liver dysfunction.

Acute Liver Failure:

A sudden and severe impairment of liver function is often caused by viral infections, drug toxicity, or metabolic disorders.

Liver Tumours:

Certain types of liver tumours, such as hepatoblastoma or hepatocellular carcinoma, may require a paediatric liver transplant as part of the treatment plan.

Rapid Decline in Liver Function:

Children experiencing a rapid deterioration in liver function, as indicated by blood tests and clinical symptoms, may be candidates for a transplant.

Need for liver transplant in kids

Life-Threatening Complications:

Severe complications related to liver diseases, such as internal bleeding, recurrent infections, or failure to thrive, may necessitate a transplant.

Budd Chiari Syndrome:

  1. A rare liver condition
  2. The blood flow from the liver is blocked or restricted due to the narrowing or clotting of veins carrying blood away from the liver.
  3. The liver plays a very important role in filtering and processing blood, so when the veins are blocked, blood backs up and accumulates in it. It can lead to impaired liver function, damage, and scarring.
  4. Anticoagulant therapy, thrombolysis and TIPS are the modes of treatment.
  5. Transjugular Intrahepatic Portosystemic Shunt (TIPS) - A Tube-like device (stent) is inserted into the liver to redirect blood flow.
    Percutaneous Transluminal Balloon Angioplasty (PTBA) - A thin tube with a balloon at the end is inserted into a blood vessel to open a blocked vein.

  6. Without treatment, Budd-Chiari syndrome can lead to liver failure and death within 3 months to 3 years of diagnosis.
  7. With liver transplant, the outcome is excellent, with an overall 5-year survival rate of 90%.

Crigler–Najjar Syndrome:

  1. There is a buildup of unconjugated bilirubin in the blood due to the lack of an enzyme. This leads to yellowing of the skin (jaundice) in children.
  2. Liver transplantation is the sole and effective treatment for Crigler-Najjar type 1, with good prognosis post-transplant i.e. 86-100% at 1 year and 81-95% at 5 years
  3. Without a transplant, the lifespan is no more than two years.

Wilson’s Disease:

  1. A genetic condition where the body cannot remove copper.
  2. The copper accumulates in the liver, brain, eyes, and other organs, leading to severe brain damage, neurological issues, and liver failure.
  3. Patients with acute liver failure from Wilson's disease require a liver transplant.
  4. Survival-rate post-transplant:
    89% at 1 year
    82.9% at 3 years
    75.6% at 5 years

Glycogen Storage Disease (GSD):

  1. It is a rare inherited condition that alters how the body utilises and stores glycogen, a type of sugar.
  2. The absence of glycogen-breaking enzymes leads to the accumulation of glycogen in the liver.
  3. Survival rate post-treatment: 92% at one year, 84% at five years
  4. Individuals with GSD type I and II may not live post-childhood, while those with type III and IV can have a normal lifespan with appropriate treatment.

Other Conditions in Children Requiring Liver Transplant

Conditions in Kids

Maple Syrup Urine Disease (MSUD)


Progressive Familial Intrahepatic Cholestasis (PFIC)

Propionic Acidemia


Primary Methylmalonic Acidemia

Urea Cycle Disorders

Mitochondrial Diseases

Mngie Syndrome

Alpha-1-Antitrypsin Deficiency (AATD)

Cystic Fibrosis

Contraindications to Liver Transplant

Current contraindications to liver transplantation in children are:

  1. Unresectable extrahepatic malignant tumour
  2. Concomitant end-stage organ failure
  3. Uncontrolled sepsis
  4. Irreversible neurological damage

Contraindications to Liver Transplant

How is Paediatric Liver Transplant Performed?

The paediatric liver transplant procedure is complex and intricate, requiring meticulous planning, skilled surgeons, and a dedicated medical team (anaesthesiologists, hepatologists, and critical care specialists). This procedure involves several stages and takes approximately 6 to 7 hours to complete based on the complexity of the case and various other factors.

Here is an overview of how pediatric liver transplant is typically performed:

  1. Evaluation and Pre-transplant Preparation: Before the transplant, the child undergoes a thorough evaluation to assess their overall health and suitability for the procedure. This includes blood tests, imaging studies, and other diagnostic tests. The child is also evaluated for organ compatibility and placed on the waiting list for a suitable liver donor.

  2. Anaesthesia and Incision: The child is taken to the operating theatre and is given general anaesthesia to ensure a painless and comfortable treatment. A surgical cut is done in the upper right side of the abdomen to access the liver.

  3. Donor Liver Retrieval: In a paediatric liver transplant, the liver can be obtained from a deceased donor or, in some cases, a living donor, typically a family member. The donor's liver is carefully retrieved, preserving its blood vessels and bile ducts.

  4. Donor Liver Implantation: The diseased liver is removed from the child's body, and the healthy donor liver is positioned and connected to the child's blood vessels and bile ducts. The surgeon ensures proper blood flow to the new liver by carefully reconnecting the blood vessels.

  5. Biliary Reconstruction: The bile ducts of the new liver are meticulously attached to the child's bile ducts or the small intestine, allowing the flow of bile from the liver.

  6. Closure and Recovery: The incision is closed using sutures or staples once the transplant is complete. The child is then transferred to the recovery room for close monitoring.

Paediatric Liver Transplant Procedure Image

When determining the donor criteria for a paediatric liver transplant, several factors are considered by a team of medical professionals. The decision to proceed with a transplant is made after a thorough evaluation of the child's overall health, the severity of the liver condition, and the effectiveness of other treatment options.

What to Expect Before and on the Day of Paediatric Liver Transplant?

Embarking on a paediatric liver transplant journey can overwhelm the child and their family. Preparing for a paediatric liver transplant involves careful planning, medical evaluations, and emotional support.

By understanding what to expect before and on the day of the transplant, families can be better prepared to navigate this transformative journey.

Before the Paediatric Liver Transplant

The surgeon will provide complete information about the procedure duration, cost, and insurance formalities. The family members may expect the following before their child's liver transplant surgery:

  1. Medical Consultations: The child will undergo a series of consultations with the transplant team, including the transplant surgeon, hepatologist, anaesthesiologist, and other specialists. 

    1. These consultations aim to gather detailed medical information, discuss the procedure and potential risks, and address any concerns or questions.

    2. The doctor would also perform a pre-anaesthesia check-up before the surgery to check for any abnormalities and allergic reactions to the anaesthesia on the child.

    3. The doctor would also need detailed information about the medical history of the child. If the child has recently had a cold, flu or fever or been exposed to chickenpox or other infectious diseases, ensure that the child does not have any other life-threatening condition, such as cancer. 

  2. Pre-Transplant Evaluations: The pre-transplant evaluations for a paediatric liver transplant include blood tests, imaging studies(ultrasound or MRI), liver biopsy, cardiac assessments, and consultations with various specialists. These evaluations help ensure that the child is in optimal medical condition for the transplant and that any underlying health issues are addressed.

  3. Donor Compatibility Assessment: If there is a living donor liver transplant in children, compatibility tests are conducted to determine the donor's suitability and assess the liver's compatibility.

    1. In the case of the living donor, the doctor may provide a tentative surgery date, subject to the results of the pre-anaesthesia check-up and other tests.
      The final date of surgery will be provided based on the tests. 

    2. The doctor may require further tests before giving the go-ahead for the procedure.

  4. Psychological Support: Children and their families should be offered psychological support and should be in touch with liver transplant support groups for children in India to help them cope with the emotional challenges of the transplant process. This support may include counselling, education, and resources for emotional well-being.

  5. Preparing for Surgery: Once the child is deemed eligible for a transplant, preparations are made for the surgical procedure. This involves scheduling the surgery, arranging for a suitable donor (deceased or living), and coordinating with the transplant team and support staff.

On the Day of the Paediatric Liver Transplant

The parents may expect the following for their child on the day of the liver transplant:

  1. Admission to the Hospital: The child will be admitted on the day of the transplant. The family will be guided through the admission process and assisted with necessary paperwork and documentation. The parents should take the child to the hospital a few hours before the surgery to reduce anxiety and make the child accustomed to the hospital environment.
  2. Preoperative Preparations: Before the surgery, the child will undergo preoperative preparations, including fasting for a specified period, taking preoperative medications as instructed, and preparing for anaesthesia administration. The nurse will also check the vital parameters of the child, such as blood pressure, heartbeat, and oxygen saturation.
  3. Anaesthesia Administration: An experienced anaesthesiologist will give the child general anaesthesia (GA) once in the operating room. This ensures that they are completely asleep and pain-free during the procedure.
  4. Supportive Care: While the child is in surgery, the medical team ensures that the family is informed about the progress. They receive updates and a comfortable waiting area during this time.

What to Expect After Paediatric Liver Transplant?

Post-transplant care for children undergoing liver transplants includes measures such as the right diet, medications, and lifestyle changes to achieve high paediatric liver transplantation success rates.  With the help of these measures, children can be on their way to quick and consistent recovery. 

The Recovery Process at the Hospital

After a paediatric liver transplant, the initial recovery phase occurs in the hospital under close medical supervision. The child would need to stay at the hospital for 10 to 15 days before getting discharged.

Here's what one can expect during the recovery process:

  1. Shifting to the Recovery Room: The child will be shifted to a dedicated recovery room where their vital signs will be continuously monitored. 

    1. This includes regular heart rate, blood pressure, oxygen levels, and temperature checks. The anaesthesia's effect will also be monitored closely.

    2. Various tubes, such as endotracheal tubes and IV lines, will be removed as the patient stabilises and recovers in the hospital.

    3. The staff will also change the abdominal dressing during their stay at the hospital.

  2. Pain Management: Adequate pain management is a priority during recovery. The medical team will closely monitor and address the child's pain levels, adjusting medications to ensure comfort.

  3. Infection Management: Preventing and managing infections is crucial during recovery. The child will receive appropriate antibiotics or antiviral medications to minimize the risk of infection.

  4. Mobility and Physiotherapy: Depending on the child's condition and the specific surgical procedure, early mobilisation and physiotherapy may be encouraged to promote healing, prevent complications, and restore strength and range of motion.

  5. Potential Discharge Scenarios: Depending on the specific circumstances and the child's condition, there are different possibilities following the transplant:

    1. Discharge after Stabilization: If the child's condition remains stable and there are no complications, they may be discharged from the hospital.

    2. Transfer to ICU or Private Room: Sometimes, the child may require closer monitoring in the Intensive Care Unit (ICU) or a private room before discharge.

    3. General Ward Stay: If the child requires more extended recovery or medical care, they may be transferred to a general ward for ongoing monitoring.

  6. Discharge and Home Care Instructions: If the child's condition stabilizes and they meet the necessary criteria, they will be discharged from the hospital. The medical team will provide detailed instructions for home care, including wound care, medication administration, and guidelines for a healthy recovery.

Recovery Process/Expectations After Hospital Discharge

One needs to know that there are several risks and compilations of paediatric liver transplants. The long-term outcomes of paediatric liver transplant and the recovery process should be strictly considered and continued after getting discharged from the hospital.
Here's what to expect during this phase:

  1. Diet and Lifestyle: The child will receive specific dietary recommendations to support their recovery and maintain optimal liver function. 

    1. This may include a well-balanced diet rich in vitamins, vegetables, lean proteins, and whole grains while limiting processed foods, fats, and sodium. 

    2. Following these guidelines is essential to support the liver's healing process.

  2. Wound Care: Regular wound care prevents infection and promotes healing. The medical team will provide instructions on how to care for the incision site, including cleaning, dressing changes, and signs of infection to watch out for.

  3. Medication Management: The child must take immunosuppressive medications to prevent organ rejection. It is crucial to strictly stick to the prescribed medication regimen and attend regular follow-up appointments to monitor medication levels and make necessary adjustments.

  4. Psychological Support: Undergoing a liver transplant can be emotionally challenging for the child and their family. It's important to seek psychological support, including counselling or support groups, to address any psychological or emotional concerns that may arise during recovery.

  5. Physiotherapy: Depending on the child's specific needs, they may be recommended to undergo physiotherapy sessions to aid in regaining strength, mobility, and overall physical function.

    1. The parents may need to encourage the child to walk to improve strength and bowel movement.

    2. The child can also indulge in gentle exercises such as flexibility exercises, strengthening exercises, aerobic exercises, and coughing and deep breathing exercises.

    3. However, parents must abstain their child from swimming for at least three months after the surgery due to the risk of infection. 

    4. The child will be allowed to play most sports a few months after the surgery. However, contact sports, such as boxing, martial arts, and wrestling, should be avoided due to the increased risk of injury.

First Follow-Up Appointment

The first follow-up appointment after a paediatric liver transplant is a crucial step in the ongoing care and monitoring of the child's health. The first follow-up visit may be scheduled within one to two weeks after the surgery.

Here's what to expect during this appointment.

  1. Comprehensive Evaluation: The medical team will conduct a comprehensive evaluation, including a physical examination, blood tests, imaging studies, and liver function assessments. These evaluations help assess the progress of the transplant, monitor liver function, and identify any potential complications or issues that need to be cleared.
  2. Medication Review: The transplant team will review the child's medication regimen, assess the effectiveness of the immunosuppressive medications, and make any necessary adjustments to ensure optimal immunosuppression while minimising side effects.
  3. Addressing Concerns and Questions: The follow-up appointment allows the child and their family to discuss any concerns or questions. The transplant team will provide guidance, address any issues, and offer support throughout the recovery process.
  4. Long-Term Care Plan: The transplant team will work with the child and their family to develop a long-term care plan during the follow-up appointment. This plan may include regular follow-up appointments, ongoing monitoring of liver function, and strategies for maintaining a healthy lifestyle to support the transplanted liver.

Paediatric Liver Transplant Survival Rate and Life Expectancy

The survival rate and life expectancy after a paediatric liver transplant can vary depending on several factors, including the underlying condition, the overall health of the child, the expertise of the transplant centre, and post-transplant care. 

  1. Survival Rate: Paediatric liver transplant has shown significant advancements over the years, resulting in improved survival rates. 

    1. According to data from reputable transplant registries and studies, the overall survival rate for paediatric liver transplant recipients is generally high. 

    2. The one-year survival rate typically ranges from 80% to 90%, while the five-year survival rate can be around 70% to 80% or higher, depending on the specific circumstances.

  2. Life Expectancy: In cases where the child is free from different health complications and challenges, the child's liver transplant life expectancy has been known to go up to 20 years.
    However, it is essential for one to constantly stay in touch with their healthcare providers for complete prognosis and diagnosis. 

  3. Long-Term Outcomes: With ongoing advancements in medical care and immunosuppressive medications, the long-term outcomes for paediatric liver transplant recipients have also improved. Many children can enjoy a good quality of life, experience normal growth and development, and participate in regular activities following successful liver transplantation.

Some Facts on Liver Transplant in Kids

There are some amazing facts about liver transplants in children that one should know.

Some Facts on Paediatric LTP

Paediatric Liver Guidelines 

Paediatric liver transplant guidelines are a set of rules established to ensure the utmost level of care for paediatric patients, not just immediately before and after the surgery but for a long time.

The primary purpose of these guidelines is to ensure that the transition phase from childhood to adulthood remains smooth. The paediatric liver transplant guides are as follows.

  1. Selection of the candidate for paediatric liver transplant and risk management. 
  2. Patient consent, optimisations, and appropriate timing before the transplant.
  3. Intraoperative measures and postoperative considerations for the patients.
  4. Minimum age for a liver transplant.
  5. Proper care and management of post-operative patients moving from intensive care units.
  6. Smooth transition of paediatric liver transplant patients from hospital to home.
  7. Ensuring that there are no other existing health conditions.
  8. Evaluation and treatment of existing health conditions.

Evaluation of the Transplant

The main aim of the evaluation process is to find the right candidates for liver transplantation and set up a plan before the transplant.

Here are the steps typically involved:

  1. Confirm why the transplantation is needed.
  2. Assess how severe the disease is.
  3. Explore other treatments besides transplantation.
  4. Make sure there are no reasons that make transplantation unsuitable.
  5. Check for any current infections and understand the child's immune system.
  6. Verify if there are heart issues that need to be treated before transplantation.
  7. Create a plan before the transplant, like vaccinations, improving nutrition for growth, dental care, and managing side effects of medications.
  8. Explain the transplantation procedure and what to expect after to parents and, if possible, the patient to prepare them for the procedure and potential complications.
  9. Evaluate the family's social situation and any concerns.


According to Paediatric Liver Transplantation research, they developed a scoring system called the Paediatric End-Stage Liver Disease score (PELD). This score uses the following factors:

  1. Bilirubin levels
  2. INR (a measure of blood clotting)
  3. Serum albumin levels
  4. Age over one year
  5. Growth problems to predict the likelihood of mortality while waiting for a liver transplant

Furthermore, they also consider additional PELD points for certain risk factors not included in the initial PELD calculation. These factors include the following conditions:

  1. Hepatopulmonary syndrome
  2. Metabolic diseases
  3. Liver tumours

Our Presence in Cities

HexaHealth has a big chain of hospitals and doctors in multiple cities. Following are the cities in which we are present:

Our Presence in Cities

Top Paediatric Liver Transplant Hospitals

When we talk about any procedure in kids, the choice of hospital and doctors matters a lot. HexaHealth helps you find what is best for you and your child.

Top Paediatric Liver Transplant Hospitals Image

Top Paediatric Liver Transplant Surgeons

Embarking on a paediatric liver transplant journey can overwhelm the child and their family. Preparing for a paediatric liver transplant involves careful planning, medical evaluations, and emotional support.

Top Paediatric Liver Transplant Surgeons Image

India’s 1st National Liver Board

HexaHealth has a panel of 5 top expert Paediatric Liver specialists who will together discuss and share end-to-end guidance and treatment plans based on your medical condition.

The NLB panel in India consists of the following experts.

  1. Dr K R Vasudevana renowned liver transplant specialist and GI Surgeon in Noida with 25 years of experience.
  2. Dr Manik Sharmais a well-known Medical Gastroenterologist with 15 years of rich experience.
  3. Dr C P S Chauhan, one of the best Interventional radiologists with a rich experience of 21 years. 
  4. Dr Atul Sharma, an eminent Medical Oncologist in Noida with a rich experience of 16 years. 
  5. Dr Abhishek Gulia, a well-known Radiation Oncologist with a vast 16 years.

National Liver Board

Highlights of the National Liver Board

  1. Combined opinions from 5 highly experienced experts
  2. To make sure your diagnosis is correct
  3. Quick response to patient queries with suitable recommendations
  4. Single window for all liver care opinions
  5. Avoid unnecessary cost burden

We are "Educating, Advocating, and Saving Lives: National Liver Board"

Cost of Liver Transplant Treatment

NOTE: Cost of the liver transplant treatment

Cost varies mostly according to 

  1. Hospital chosen
  2. Financial assistance is available and
  3. Medical condition of the recipient

Cost Breakup

  1. Pre-Transplant workup costs: 1 - 1.5 lakhs
  2. The package cost for Surgery and Hospital stay for both Donor and Recipient is around 18 - 23 lakhs
  3. Crowdfunding available with help from MILAAP, KETTO, IMPACTGURU

Who Can be a Liver Donor?

The liver donor must be a family member aged 18-55 yr old, weighing 50-90 kg and the same blood group or blood group O.

Donor's initial assessment includes the following tests to assess liver condition

  1. Blood group
  2. CBC
  3. LFT
  4. Creatinine level
  5. HBsAg
  6. Anti-HCV
  7. HIV-I-II, and conducting
  8. Ultrasound or CT scan

After finding a suitable donor, the patient and donor must go through a Legal Authorization Committee.

Legal Authorisation Committee

The committee aims to monitor the authorisation procedure to approve or reject transplants between the recipient and donors.

  1. If the donor is married, their spouse must accompany them.
  2. If unmarried, parents or siblings (with a No Objection Certificate from parents) must be present for the legal authorization committee.
  3. Provide divorce or death certificates if applicable (for parents, next of kin, or the donor's spouse).
  4. Submit at least 5 pictures from different years showing the patient and donor together, including wedding or marriage photographs and other family pictures.
  5. Prepare 25 passport-sized photographs with a white background for the patient, patient's relative, donor, and donor's spouse/parent/ siblings.
  6. The donor should not have a drug addiction or a criminal record.
  7. Present income proof for the donor and their spouse, parent, or siblings, like 3 years of bank statements or financial documents.
  8. HLA/DNA testing (Form 5) will be done during this process.
  9. If the donor is a second-degree relative, obtain Form 20 and have it attested by the Tehsildar for verification, providing their email ID.
  10. The hospital where you plan to get admitted will provide an affidavit format, which should be created in the same city.

After the Legal Authorisation Committee

  1. Consult with a liver transplant surgeon for diagnosis and assessment.
  2. Confirm liver transplant as the recommended treatment.
  3. Identify a suitable liver donor from your immediate family*.
  4. Conduct diagnostic tests to match donor and recipient. Donor's tests are typically outpatient, and recipients may be inpatient if required.
  5. Pre-transplant workup typically takes 5-7 days, expedited to 24-48 hours in emergencies.
  6. A government-authorised committee verifies donor and recipient documents.
  7. Both patient and donor are admitted.
  8. Proceed with a living donor transplant if they match and consent is given.
  9. If there is no match, register for a deceased donor transplant in government registries like NOTTO and state directories.
  10. Perform surgery after securing a donor, transfer patient to ICU for postoperative observation.
  11. Hospital stay lasts 20-25 days, depending on recovery.
  12. The patient is discharged and advised to stay locally for regular follow-up appointments.
  13. Patients can return home when fully recovered.

Benefits of Paediatric Liver Transplant

One of the safest and most effective procedures for curing liver ailments in children, paediatric liver transplants help children overcome their medical conditions and find their way to a normal and healthy existence. 

There are many qualified paediatric liver transplant surgeons in India, ensuring that the long-term outcomes of paediatric liver transplant is a positive. 

Here are some key benefits of paediatric liver transplants:

  1. Improved Quality of Life: Paediatric liver transplants can significantly enhance the quality of life for children with severe liver diseases. It can alleviate symptoms associated with liver failure, such as fatigue, jaundice, poor growth, and cognitive impairment, allowing children to lead more active and fulfilling lives.
  2. Prolonged Survival: Liver transplant offers the potential for prolonged survival in children with end-stage liver disease. Studies have shown that the survival rates for paediatric liver transplant recipients have improved over the years, with many children experiencing long-term survival and the possibility of a near-normal life expectancy.
  3. Resolution of Underlying Liver Disease: A liver transplant provides a definitive solution to various liver diseases that are otherwise incurable. The underlying disease process is halted by replacing the damaged liver with a healthy donor liver, allowing children a chance at a healthy life.
  4. Removal of Cancerous Liver: Paediatric liver transplant can benefit children diagnosed with liver cancer, such as hepatoblastoma or hepatocellular carcinoma. Transplantation allows for completely removing the cancerous liver, providing a better chance of eliminating the cancer and preventing its recurrence.
  5. Normal Growth and Development: Growth and development may be affected for children with chronic liver disease. A paediatric liver transplant can promote normal growth patterns and developmental milestones by ensuring the child receives a healthy and functioning liver.
  6. Improved Nutritional Status: A liver transplant can improve the body's ability to digest and absorb nutrients, leading to improved nutritional status. This can help address issues such as malnutrition and failure to thrive commonly associated with advanced liver disease.
  7. Enhanced Cognitive Function: In conditions where liver disease affects brain function, such as in certain metabolic disorders, paediatric liver transplants can improve cognitive function and prevent further neurological deterioration, allowing children to reach their full intellectual potential.
  8. Opportunity for a Normal Childhood: Paediatric liver transplant enables children to participate in regular activities, attend school, and engage in social interactions without the limitations of liver disease. It allows them to have a more normal childhood experience and pursue their dreams and aspirations.

Risks and Complications of Paediatric Liver Transplant

While a paediatric liver transplant is a sophisticated procedure, it's essential to be informed of potential risks and complications associated with the surgery. 

However, at the same time, one must also know that not all patients will have the same complications and are sure to vary from one person to another. The most common risks and complications include: 

  1. Bleeding: Just like any other medical procedure, there is a risk of bleeding and damaged blood vessels.
  2. Bile Duct Complications: Complications such as leaks and blockages can occur post-liver transplant surgeries, leading to infections and damage of the liver cells.
  3. Infections: The use of certain medications in the liver transplant can cause multiple types of infections such as fungal, bacterial, urinary tract, etc.
  4. Rejection of the Donated Liver: In many cases, the immune system of the recipient has been known to reject the acceptance of the foreign organ, causing problems.
  5. Mental and Psychological Impacts: A person has been known to suffer from mental and psychological issues such as anxiety, depression, fear, etc., post surgeries. Sometimes, the stress levels can also lead to other mental problems.

However, it's important to note that the medical team will closely monitor the child's condition and take necessary precautions to minimise these risks. Regular follow-up visits and open communication with the medical team are vital in mitigating potential complications.

When is Consultation with the Doctor Needed?

Throughout the child's recovery journey, it's essential to maintain open communication with the medical team and seek consultation when needed. It is recommended to contact the doctor if the child experiences any concerning symptoms. These symptoms include 

  1. Fever
  2. Weakness and fatigue
  3. Mental confusion or seizures
  4. Significant changes in appetite or behaviour
  5. Persistent pain does not reduce with time
  6. Swelling and abscess at the site of the incision
  7. Signs of organ rejection 

Prompt medical attention can help address potential issues and ensure the best possible solution for the child's health.

Risks of Delayed Paediatric Liver Transplant

Delaying a paediatric liver transplant can have serious consequences. Liver diseases and conditions can progress rapidly in children, leading to further deterioration of their health and potential complications. 

It's important to recognize the potential risks associated with delaying the procedure and the impact they can have on a child's health. Here are some common risks of a delayed paediatric liver transplant, supported by trusted sources:

  1. Disease Progression: Liver diseases that require transplant can progress over time, leading to further deterioration of liver function.  Delaying the transplant can allow the underlying disease to worsen, increasing the risk of complications and reducing the chances of a successful transplant outcome.
  2. Malnutrition and Growth Impairment: Children with end-stage liver disease often experience malnutrition and growth impairment. Delaying the liver transplant can exacerbate these issues, as the liver's ability to metabolise and absorb nutrients becomes further compromised. This can impact a child's overall growth, development, and overall well-being.
  3. Increased Risk of Infections: Children with advanced liver disease have a weakened immune system, making them more susceptible to infections. Delaying the liver transplant can prolong this immunocompromised state, increasing the risk of serious infections that can further compromise the child's health.
  4. Development of Complications: End-stage liver disease can lead to the development of various complications, such as portal hypertension, ascites (accumulation of fluid in the abdomen), hepatic encephalopathy (brain dysfunction due to liver failure), and variceal bleeding. Delaying the liver transplant can increase the likelihood of these complications occurring or worsening, which can be life-threatening.
  5. Impaired Organ Function: As liver disease progresses, the liver's ability to perform its vital functions, such as detoxification, synthesis of clotting factors, and metabolism of medications, becomes compromised. Delaying the liver transplant can result in further impairment of these functions, leading to a higher risk of complications and a decline in overall health.
  6. Psychological and Emotional Impact: Delaying the liver transplant can have a significant psychological and emotional impact on the child and their family. Living with the uncertainty of the disease progression and the need for a life-saving procedure can lead to increased stress, anxiety, and emotional burdens for all involved.

Timely intervention can significantly improve the chances of a successful transplant and enhance the overall prognosis for the child. Thus, it is crucial to consult with the medical team and follow their recommendations regarding the timing of the transplant. 

Cost of Paediatric Liver Transplant

The cost of a paediatric liver transplant in India with standard complications is significantly lower than in other countries. There are some of the best paediatric liver transplant hospitals in India that provide services at an affordable cost. 

On average, the cost of a paediatric liver transplant in India is approximately between ₹ 15,00,000 to ₹ 25,00,000. However, it's important to consider that these are approximate figures, and the actual cost can vary based on individual circumstances. 

There are several factors that influence the cost of paediatric liver transplants. Some of these factors are as follows: 

  1. Patient’s age
  2. Type of donor
  3. Doctor’s expertise 
  4. Location and type of hospital
  5. Pre and post-treatment medications 
  6. Physiotherapy and rehabilitation 

It is advisable to consult with the medical facility and discuss the financial aspects, including insurance coverage and potential financial assistance programs available.

Why HexaHealth?

HexaHealth is the leading healthcare provider in India. Our AI-powered platforms and focus on positive patient experience are just some benefits. Are you curious why we are the best choice for your hepatobiliary cancer treatment? Here are some of the facilities you can avail yourself of:

  1. Helping you choose the best hospital per location and finances 
  2. Easy consultation booking with the best doctor at ease 
  3. Second opinion from multiple specialist surgeons (National Liver Board)
  4. Hassle-free treatment cost estimates (look at the services and  modify accordingly) 
  5. Assistance with finances and treatment budget 
  6. Prioritisation of quality over everything else 
  7. 24/7 Personalised care support 
  8. Post-operative care (home care, hospital transfers, etc.)

Why HexaHealth


Paediatric liver transplantation (LT) emerges as highly successful for kids facing advanced and irreversible liver failure. It has an impressive success rate of approximately 95%. It offers patients a pathway to a healthy life.

HexaHealth is committed to delivering top-notch and cost-effective liver transplant surgeries in India, ensuring accessibility for those in need.

Don't hesitate to reach out for details on the procedure, costs, hospital stay, financing options, and post-surgery recovery. We are here to provide comprehensive information and support.

Contact Us

Handling healthcare can be overwhelming. It may impact your finances, social life, and mental well-being. That’s where HexaHealth steps in. HexaHealth is your all-in-one solution, committed to providing the best doctors and guidance throughout your healthcare journey.

We offer a range of services, including doctor appointments, coordinating diagnostic tests, planning admissions, providing out-of-hospital support, giving psycho-social counselling, and educating about your condition. Through our wide network of top hospitals and expert paediatric liver transplant specialists across India, we connect you to the best possible care.

You don't have to stress about money. We let you pay for your treatment with zero-cost EMI plans up to 4 lakhs over 12 months. We offer competitive interest for larger amounts and longer terms so you can access the best financial support.

We know that dealing with the emotional and mental toll of healthcare can be tough. HexaHealth handles the logistics and support, allowing you to concentrate on your recovery and find peace of mind.

Start your path to better health today by dialling 6366529758 to book your first appointment with the finest doctor. The nation's leading liver transplant centre is just a call away, so get started!

Expert Doctors

Dr. Ashok Kumar Sharma
Hexa Partner


55+ Years




Dr. Anurag Krishna
Hexa Partner


39+ Years




NABH Accredited Hospitals

Sahyadri Narayana Multispeciality Hospital, Harakere

Sahyadri Narayana Multispeciality Hospital, Harakere

4.8/5(91 Ratings)
Harakere, Shimoga
Madhukar Rainbow Children Hospital, Delhi

Madhukar Rainbow Children Hospital, Delhi

4.8/5(44 Ratings)
Malviya Nagar, Delhi

Frequently Asked Questions (FAQ)

A procedure or an operation where the deceased or damaged liver of a child is replaced with a healthy and properly functioning liver can be explained as a paediatric liver transplant.

The primary purpose of paediatric liver transplant is biliary atresia and also to cure many other related health conditions.


To obtain the proper guidelines, a person needs to consult their healthcare provider. However, the general paediatric liver transplant guidelines are as follows:

  1. Indications 

  2. Evaluations 

  3. Organ allocations 

  4. Surgical procedure

  5. Post-transplant care 

  6. Long term outcomes


As per the Euro transplant liver allocation system, the age for paediatric liver transplant is at 16 years or younger.


The eligibility criteria for paediatric liver transplant in India depends on the following factors.

  1. End-stage liver disease

  2. Failed medical management

  3. A rapid decline in liver functions 

  4. Progressive liver damage

  5. Life-threatening complications 


It is essential for one to know that the erratic liver transplant is a complex procedure. There is no fixed minimum age limit for liver transplants in India, and the decision is made based on the overall health of the child and the specific guidelines of the healthcare facilities.


Unless the child suffers from other diseases, the child's liver transplant life expectancy in about 80% of the cases is up to 20 years without any problems and complications. However, one must know that signs and symptoms will vary from one person to another.


There are several factors that determine the liver transplant life expectancy in India. These are the child's overall health, age, body's response to the treatment, comorbidities, type of transplant surgery, etc.


Yes, there are certain age restrictions for the availability of liver transplant donors in India. According to the donor criteria for paediatric liver transplant, the age group of the donor should be between 18 and 60. And most importantly, they should be willing and happy to do what they are doing.

The other factor considered for the donors of paediatric liver transplants in India is that they should be healthy, maintain the right weight, not be obese, and have the matching blood group as the donor or O blood group.


There has been an exponential growth in paediatric liver transplants in India. There are more than 135 centers all across the country that are performing 1500 to 2000 liver transplants annually. Out of these numbers, 10% of cases are paediatric.
Surpassing a survival rate of 90%, India's paediatric liver transplant success rates are at a high like never before.


A paediatric liver transplant is a complex procedure requiring proper care before and after the surgery. The top hospitals in India that specialize in paediatric liver transplants are :

  1. Artemis Hospital, Gurgaon

  2. kokila dhirubhai Ambani hospital. Mumbai

  3. Apollo Chennai, Chennai

  4. BLK super specialty hospital, Bangalore

  5. Fortis memorial research institute, Gurugram


Many factors, such as the type of liver condition, the medical team, and the choice of hospital, determine the liver transplant's total cost. However, in most cases, the price of a paediatric liver transplant in India starts from ₹ 15,00,000 and can go up to ₹ 25,00,000. However, one needs to know that these are approximate costs, and the total expenditure may vary from one case to another.


A liver transplant is an expensive treatment and in many cases, financial assistance is a must for people to ensure smooth medical journeys. Fortunately, many financial provisions for Paediatric liver transplants in India can come to a person's rescue and help them in the long run. These are :

  1. Health insurance 

  2. Crowdfunding 

  3. Medical loans

  4. Non-government organizations 

  5. Government assistance & programs, etc


In most cases, patients must stay in the hospital for at least ten days post their Paediatric liver transplants in India. The patients are prescribed a list of medications that helps control their infections and the acid-making agents. 

However, one needs to be careful about immunosuppression after Paediatric liver transplantation and stay in touch with their healthcare providers at regular intervals to ensure that there are no problems, and if issues do exist, they can be started at the right time to avoid complications.


Even though the success of paediatric liver transplants in India is high, one needs to be aware of all the risks and complications associated with this problem. These include infections, organ rejection, complications caused by immunosuppressive medications, and surgical complications.

However, one needs to know that these problems are not alarming as they can be treated with the right medical help and supervision.


Yes, alternative treatment therapies are available for paediatric liver diseases in India. However, one must consult their healthcare providers before adopting these measures. These include :

  1. Medications 

  2. National support

  3. Interventional procedures

  4. Phototherapy 

  5. Liver support system


Even though many people get liver transplants every year, a more significant number of patients get added to the queue for finding a donor. The waiting period depends on the paediatric liver transplant waiting list and the donor's availability.
However, the average waiting period can differ from 30 days to up to 5 years.


Yes, the following are the specific medical conditions that can make a child ineligible for a paediatric liver transplant in India. 

  1. Severe multi-organ dysfunction

  2. Severe systemic infections 

  3. Active substance abuse or non-compliance 

  4. Advanced malignancy

  5. Severe heart or lung disease

  6. Severe neurological impairment 


Yes, a child can receive a liver transplant from a living donor. However, as per the guidelines, in the THO act, the donor can also be a close relative of the patient, be it a parent, spouse, children, parents, etc. They need to pass the eligibility test to be a donor.


With India becoming the preferred medical destination for those looking for paediatric liver transplants, there is a significant gap in the availability and demand for the treatment. The unavailability of the donors, technical challenges, and the long queues all lead to this difference.


One of the best things about liver transplants is that they allow children to have happy and healthy adolescence and adulthood. However, to attain maximum benefits post this survey, the following lifestyle changes must always be incorporated post the paediatric liver transplant.

  1. Maintain good health with the help of diet, exercise, stress management, etc.

  2. Maintain distance from people susceptible to infections.

  3. Immunosuppressant medication prescribed by the doctor

  4. Regular physical exercise is essential to maintain overall health.

  5. Ensure regular follow-ups with the transplant team.


Yes, a child can receive a liver transplant from a living donor. However, as per the guidelines, in the THO act, the donor can also be a close relative of the patient, be it a parent, spouse, children, parents, etc. They need to pass the eligibility test to be a donor.


With India becoming the preferred medical destination for those looking for paediatric liver transplants, there is a significant gap in the availability and demand for the treatment. The unavailability of the donors, technical challenges, and the long queues all lead to this difference.


One of the best things about liver transplants is that they allow children to have happy and healthy adolescence and adulthood. However, to attain maximum benefits post this survey, the following lifestyle changes must always be incorporated post the paediatric liver transplant.

  1. Maintain good health with the help of diet, exercise, stress management, etc.

  2. Maintain distance from people susceptible to infections.

  3. Immunosuppressant medication prescribed by the doctor

  4. Regular physical exercise is essential to maintain overall health.

  5. Ensure regular follow-ups with the transplant team.


In 80% of the cases, the long-term life expectancy for children undergoing liver transplants boosts up to 20 years and more.


As per a study published in Indian paediatrics, there has been a noticeable increase in paediatric liver transplants in India. With the increase in the number of patients, there has also been a tremendous rise in advanced research for iterate, not of the same.


Other than constantly motivating and cheering patients, the role of family or caregivers in paediatric liver transplants in India is to ensure timely medication, the right diet, and proper physical activity. Taking for regular hospital visits, taking care of the financial aspects, and also keeping a check on the signs and symptoms that indicate further complications.


Let's address some common myths associated with paediatric liver transplants to dispel any misconceptions and provide accurate information:

  1. Myth: Paediatric liver transplant is a risky and dangerous procedure.

    Fact: While paediatric liver transplant carries risks like any major surgery, it is a well-established and highly successful procedure. Advances in medical technology and expertise have significantly improved outcomes, making it a life-saving option for many children.
  1. Myth: Only relatives can be organ donors for paediatric liver transplants.

    Fact: The donor criteria for paediatric liver transplant varies from one case to another. In paediatric liver transplants, relatives, deceased, and living donors can provide the recipient's child with a healthy liver. Living donor transplants, where a portion of the liver from a compatible adult is transplanted, have shown excellent outcomes in paediatric cases.
  1. Myth: A paediatric liver transplant guarantees a lifelong cure.

    Fact: While a paediatric liver transplant can greatly improve a child's health and quality of life, long-term care and monitoring is essential. Regular follow-up appointments, medication adherence, and a healthy lifestyle are crucial to ensure the ongoing success of the transplant.

  1. Myth: Paediatric liver transplant is not affordable for everyone.

    Fact: While the cost of paediatric liver transplants can be high, there are financial assistance programs, insurance coverage, and charitable organizations that can provide support and make the procedure more accessible for eligible families.



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. Spada M, Riva S, Maggiore G, Cintorino D, Gridelli B. Pediatric liver transplantation. World Journal of Gastroenterology [Internet]. 2009;15(6)
  2. default - Stanford Children’s Health [Internet].
  3. Malhotra S, Sibal A, Goyal N. Pediatric Liver Transplantation in India: 22 Years and Counting. Indian Pediatrics. 2020 Dec;57(12):1110–
  4. 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–
  5. Print. Liver Transplant - Liver transplant for children [Internet]. Mayo Clinic. [cited 2023 Jun 22].link
  6. Transplant Surgery - Liver Transplant (Pediatric) [Internet]. [cited 2023 Jun 22].link


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


Rajath R Prabhu

Rajath R Prabhu

MSc. Clinical Research I PG Diploma in Public Health Services Management

3 Years Experience

His work in medical content writing and proofreading is noteworthy. He has also contributed immensely to public health research and has authored four scientific manuscripts in international journals. He was assoc...View More

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