Can a liver transplantation be performed on a baby?

Some babies are born with a congenital malformation of the liver and bile ducts. Liver transplantation can be performed on babies. There is the possibility of a living donation and a foreign donation.

In the case of a living donation, a piece of liver tissue from a relative is surgically implanted into the sick baby. In the case of a foreign donation, the child is transplanted a donor liver from a deceased person. For a liver donation, blood group and anatomical conditions must match. Nowadays, the chances of success for liver transplantation in newborns and infants are good. There are pediatric transplant centers that are capable of transplanting necessary organs to the smallest newborn.

Procedure

If the indication for organ transplantation is given, the patient is placed on a waiting list for a donor organ. The waiting time can vary greatly, often it takes months to years until a suitable donor organ is available. Once a donor organ has been found, it is important that the operation for transplantation takes place as quickly as possible, as the functionality of the organ removed quickly deteriorates. Within 16-24 hours after the donor organ has been removed, the liver must be implanted in the recipient.

Selection of donors

In Germany, organ donation is only permitted after documented brain death and the donor’s consent (e.g. by means of an organ donor card) (Transplantation Act 1997). In Europe, the Eurotransplant headquarters in the Netherlands handles transplant allocation. The donor organs are distributed to the patients according to urgency, the decisive factor here being the remaining functional capacity of the diseased liver.

Accordingly, patients with fulminant liver failure or intensive therapy receive the highest priority level. Unlike kidney or pancreas transplants, for example, liver transplants are so-called orthotopic transplants, which means that the new organ is inserted exactly in the place of the old diseased organ. First, a large abdominal incision is made, thus opening the abdominal cavity for the surgeons.

First the old liver must be removed. For this purpose, the liver is carefully removed from the surrounding tissue and the vessels leading in and out are exposed. Next, the bile duct is severed as close to the liver as possible.

In the next step, the blood vessels of the liver are clamped off. The liver has a strong blood supply and receives its blood through the portal vein (a large blood vessel that allows all the blood from the digestive organs to flow to the liver). The blood passes through the liver and leaves the liver via the inferior vena cava, which transports the blood to the heart.

The liver also has its own blood supply via the hepatic artery. These 3 vessels (portal vein, inferior vena cava and hepatic artery) have to be clamped to remove the old liver and to avoid losing blood. Once the 3 blood vessels are clamped, the liver is disconnected from the bloodstream and can be removed.

To do this, the surgeon cuts the clamped vessels at liver level. Now the liver is exposed and can be removed from the body. The donor organ is then inserted in the place of the old liver.

For this purpose, the donor liver is connected to the patient’s vessels (portal vein, vena cava and hepatic artery).First, the vena cava of the new liver is connected to the patient’s vena cava, then the portal vein and hepatic artery are connected. If all vessels are well adapted to each other, the previously disconnected vessels can be released, allowing the liver to be supplied with blood again. Now that blood is flowing through the liver again, it is important to check for small bleedings, especially in the newly connected vessels.

Once all bleeding has been stopped, the last thing to be done is to connect the bile duct of the donor organ with that of the recipient. At the end of the operation, before the abdomen is closed again, drains are inserted in the area of the freshly operated vessel connections. These are used to drain blood, pus or wound secretion from the abdominal cavity into a container outside the body to promote wound healing.

In a liver transplant, the abdomen is opened, the diseased liver is removed and the new liver is implanted. The duration of the operation is between four and eight hours. The duration of the operation can vary, as certain circumstances and complications can make the procedure more difficult or prolong it.

In case of liver cirrhosis, portal hypertension and coagulation disorders may prolong the surgery. If there is a misunderstanding of the size of the transplanted bile ducts between donor and recipient, surgical techniques that are more time-consuming may be necessary. With four to eight hours of surgery, a liver transplantation takes on average longer than a heart or kidney transplantation.