Types of transplants
Whole Liver transplant
Historically, a whole liver graft was the only option available for infants and small children waiting for liver transplantation. In this option, the whole liver of a donor, (usually a child donor,) is used to replace the whole liver of the recipient. Children had to wait a long time for a size-matched organ. Since the late 1980’s, several new options have become available because of improved surgical techniques: reduced size liver transplant, split liver transplant and living-related liver transplantation. These options have shortened waiting times for the smallest recipients.
Reduced Size Live Transplantation
When an organ is available, the liver transplant team recovers the liver as a whole organ. Small infants will require an organ that is reduced in size, a segment of the whole liver. This procedure is performed by the surgical team just prior to the transplantation. With reduced size liver transplantation, the weight of the donor can be as much as 10 times that of the recipient. This has significantly lessened the waiting time for small children and infants and has reduced the mortality rate of those on the waiting list to nearly zero.
Studies have shown that children do just as well with a reduced size liver as with a whole liver. If you have questions about the procedure, your transplant surgeon will be happy to discuss them with you.
The advantage for this procedure is that two recipients in urgent need of a liver graft can be successfully transplanted. It can also be safely used for an elective procedure. The portion of the liver used for each recipient is determined by the size and shape of the donor organ and the respective weights of the recipients. Potential complications include a vascular thrombosis or a biliary leak, similar to the complications found in other pediatric transplant procedures.
Living-Related Liver Transplantation
The concept of living-related transplantation grew from surgical experience with segmental liver transplantations and experience gained from the resection of a portion of the liver in patients with a liver tumor. Surgeons have been able to safely resect a portion (either the left lateral segment, left lobe or right lobe) of the liver without any harm to the donor. The advantage of this technique is the ability to provide a donor for every needy recipient and the improved quality of the graft from a healthy living donor. The relief for the family providing a donor for their child rather than the anxiety of waiting an undetermined period of time must be balanced against having two loved ones undergo major surgical procedures simultaneously. The risk to the donor is minimal, however, it is important to remember that the donor is undergoing a major surgical procedure. A six to eight day hospitalization is planned; expected length of recovery for the donor is eight weeks.
The donor evaluation involves a variety of blood tests (the donor and recipient must be a blood type match), a volumetric computed tomography (CT) scan of the liver (measuring the volume of the segment to be donation), a physical examination, a psychiatric examination and finally an arteriogram of the liver to assess the veins and arteries of the liver. Once the donor is deemed a "good match," the surgical procedures are scheduled.
On the morning of surgery the “parent donor” will be taken to the surgical suites to harvest the liver segment. Your child will be taken to the operating room a few hours later. One parent may accompany the child into the operating room and stay until the child is asleep. A cover gown, mask and show covers will be provided for the parent to go into the operating room. The surgery is approximately 8 to 12 hours in length. During the surgery, one of the OR nurses or surgeons will come out to speak with you and provide you with updates on your child’s condition.
