About the Transplant Operation
The day has finally come for your child’s surgery. Some families have expressed amazement when the call comes. Once you receive the call from the coordinator, make plans to come to the hospital as quickly and safely as possible. The coordinator will ask you several questions regarding your child’s current health: does he have a cold, fever or rash or has he recently been exposed to a communicable disease (i.e. chicken pox)? Children who currently have a virus or the flu may not be a good candidate for transplantation because the immunosuppressant medications used in the post-transplantation period to prevent rejection may prolong recovery from these ordinary illnesses. The coordinator will also tell you when to come to the hospital.
Once you get the call, do not give your child anything else to eat or drink. When you arrive at the hospital, go directly to the emergency room for surgery prep. Blood work will be obtained, an IV will be started and a bowel prep will be administered to clean out the large bowel before surgery. Some of the medicine will be given through the mouth, and the remainder will be given as an enema through the rectum. Your child will also receive IV antibiotics.
Although it is rare, it is possible you could arrive at the hospital and find out the surgery has been canceled. Although many tests are done on the donor, it is only after the liver has been examined that the transplant surgeon can determine whether the donor organ is acceptable.
Two surgical teams will perform the transplant surgery; one team will remove your child’s native liver, while the second team will prepare the donor liver for placement. An incision is made in the upper part of the child’s abdomen, from right to left, occasionally with a vertical extension up to the breast bone. If your child has had a previous procedure, the Kasai procedure for example, the same incision is usually used. After the diseased liver is removed and sent to the laboratory for examination, the healthy liver is sewn in place by the transplant surgeons. Four major vessels are connected; the suprahepatic vena cava, infra hepatic vena cava, hepatic artery and portal vein.
Once these procedures are complete, the new liver will look pink and feel firm. Next the bile drainage is established with the child’s intestines. If your child has had a Kasai procedure, the biliary connection will be similar. The most common pediatric biliary connection is called a Roux-en-Y. A small plastic tube called a stent will be placed internally across the suture line between the intestine and the bile duct. This prevents the area from closing off and blocking bile flow while the healing takes place. The stent will pass out through your child’s stool within a few months after the transplant. Occasionally, your child’s bile duct and the bile duct of the transplanted liver will be large enough to connect the two ducts directly together.
