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Pediatric Liver Transplant Surgery

Depending on what type of liver transplant a patient will receive, the surgery may be scheduled or unscheduled.

Scheduled Surgery

If the patient has a living donor, the surgery will be scheduled and the patient and donor will come to the hospital as planned and scheduled with the transplant team.

Unscheduled Surgery

If the patient is waiting for a donated cadaveric liver, a call can come at any point in time. A Johns Hopkins transplant coordinator will contact the family and ask 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 eligible for transplantation at that time. This is because immunosuppressant medications are used in the post-transplantation period to prevent organ rejection; these medications 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.

It is rare, but possible for you to arrive at the hospital and find out the surgery has been canceled. Although many tests are done on the donor, transplant surgeons must examine the organ and make sure it is fit for transplant. Because of the timely nature of the surgery, you may not find whether an organ is acceptable or not until you get to the hospital.

The Operation

The liver transplant operation requires two surgical teams: One for the patient and one for the donor liver. As one team removes the child’s liver, the other team will prep the donor liver for placement. An incision will be made in the upper part of the child’s abdomen, from right to left, occasionally with a vertical extension up to the breast bone. In this video about adult liver transplant surgery, you can watch Dr. Andrew Cameron describe the incision.

After the diseased liver is removed and sent to the laboratory for examination, the healthy liver will be sewn in place by the transplant surgeons. Four major vessels are connected, and surgeons will carefully check the new liver for health and performance before closing the incision.


As with any surgical procedure, patients run the risk of complications. You will have an opportunity to discuss these risks with your surgeon. Common risks include:

Biliary leaks

Biliary leaks ay require reexploration of the liver in the operating room, or may be managed through a minimally invasive procedure performed by interventional radiology. Your surgeon will discuss your options with you.

Hepatic Artery Thrombosis

Hepatic artery thrombosis occurs in 10% - 20% of pediatric liver transplant recipients. Correction requires surgical intervention and possible retransplantation.


The risk of organ rejection is possible with any organ transplant. Rejection occurs when the body’s immune system identifies the new organ as a foreign object and tries to fight it. More than 90% of children experience organ rejection as least once. Rejection may be managed through steroid medications.


Because immunosuppressant medication is used to prevent rejection, the body is less able to fight infections. As a result, special care must be taken to limit a child’s exposure to common infections such as the influenza virus.

Post-Transplant Lymphoproliferative Disorders (PTLD)

Immunosuppressant medication affects the body’s production of white blood cells, or lymphocytes. Some white blood cells may grow uninhibited. In most cases, the amount of immunosuppression medication can be reduced to correct the problem.

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