Liver transplantation

If it seems like a liver transplant might be an option for your child, we’ll ask you to come to the hospital for an informational visit. Your family will meet our transplant team, and you’ll be invited to ask questions and share any concerns you may have. We encourage you to bring family members to this meeting.

If you and the transplant team agree that a liver transplant is an appropriate option, your child will be scheduled for an evaluation. This is necessary so that we can:

• Confirm that a transplant is the best treatment
• Determine how urgent the need for a transplant is
• Make sure that the donor organ your child receives will be a good match

The evaluation is usually completed in two days in the outpatient department.

Who will we meet with during the transplant evaluation?

A transplant is a complex procedure that involves many medical specialties, so your family will meet Boston Children’s Hospital experts from a number of different areas, including:

• Liver transplant surgery: These are the doctors who specialize in liver transplant surgery and will perform the transplant.

• Hepatology: The hepatologist is a physician who specializes in the medical evaluation and treatment of liver disease. All of the hepatologists at Boston Children’s are board certified in Pediatric Transplant Hepatology.

• Transplant nurse coordinator: This is a nurse who specializes in caring for patients who have undergone a liver transplant and will organize all aspects of your child’s care before and after the transplant. 

• Anesthesia: The anesthesiologist will review your child's medical and/or surgical histories, identify any risk factors associated with anesthesia and plan the type of anesthesia that will be specifically tailored to your child.

• Infectious disease: Our infectious disease specialist will perform a physical exam and review your child's vaccination records. We will want to know if your child has any particular environmental exposures or has recently traveled to a foreign country. 

• Psychiatry: A psychiatrist or psychologist will meet with you and your child to discuss coping strategies, stress management and family life. 

• Social services: Our transplant social worker will meet with you and your family to identify support systems and discuss your feelings about transplant. We can provide you with information about resources related to finances, transportation, relocation expenses and support groups.

• Nutrition: Our registered dietician will evaluate your child's diet and nutritional requirements. It’s important that your child maintain a healthy lifestyle and good nutrition before the transplant. 

• Physical therapy: The physical therapist will discuss the importance of exercising before transplant in a way that is appropriate for your child. The goal of developing an exercise plan is to help increase endurance and strength. 

• Dentist: Before a transplant can be considered, we often recommend that your child meet with his own dentist or one here at the hospital. The goal is to treat any cavities, infections or tooth abscesses before the operation, since these conditions can be problematic once your child begins to take medicine to suppress his immune system.

If your child has any other medical problems such as a lung condition (e.g. asthma or cystic fibrosis) or heart disease, other specialists may be included to fully assess your child’s
 

What tests are used during the evaluation?

Your child’s specialists will order different tests to rule out infections, determine functionality of organs and make sure a donor match is compatible. These types of tests may include:

1. Blood

• Blood type (donor and recipient must have compatible blood)

• Blood tests that measure how long it takes for your child’s blood to clot (often used to check liver function)

• Kidney function tests

• Some tests to check for exposure to viruses, bacteria, and infections including:
  • Hepatitis A, B and C
  • HIV 
  • Cytomegalovirus
  • Epstein Barr Virus 
  • Herpes simplex virus (HSV)

2. A skin test or other test for tuberculosis (TB) if this has not already been done by your child’s physician. In this test, a doctor or nurse injects a small amount of testing fluid just under the skin on the under side of your child’s forearm. After two or three days, the test is checked. If a certain size bump has developed, the test may be positive for TB exposure or infection.

3. Other kinds of tests

• Abdominal ultrasound to see the liver and flow of blood through your child’s arteries and veins

• Sometimes a CT scan is needed to better show the anatomy of the bile ducts or the blood vessels in and around the liver

After these consultations and tests, our transplant team will meet as a group to determine whether your child is a good candidate for a liver transplant and to determine the best time for your child to be placed on the transplant waiting list. Our multidisciplinary approach to care ensures that your child’s case will be given thoughtful discussion of every treatment possibility.

If your child is a transplant candidate, we’ll make sure your family is fully educated about the risks and benefits, and your child will be placed on the United Network for Organ Sharing (UNOS) waiting list. You will receive notification verbally and in writing when this happens.

To speak with a member of our Liver Transplant Team, please call:  617-35-LIVER or click here.