Liver transplantation facts for kids

A liver transplant is a surgery to replace a sick liver with a healthy liver from another person. This procedure can be a life-saving treatment for people with serious liver diseases when their own liver stops working correctly.

Getting a new liver is a very big deal. The process is carefully managed by special doctors and hospitals. Finding a matching donor liver is one of the biggest challenges, as there are more people who need a new liver than there are available organs.

Why Is a Liver Transplant Needed?

A liver transplant is only considered when a person's liver is so damaged that it can't be fixed. This is called "end-stage" liver disease. The surgery has risks and requires big life changes afterward, so it's only for the most serious cases.

Doctors use scoring systems to decide who needs a transplant most urgently. These systems look at different health measurements to see how sick a person's liver is. A higher score means a greater need for a new liver. This helps make sure that the available organs go to the people who need them most.

Who Can Get a Transplant?

A team of doctors, surgeons, and other health experts work together to decide if a person is a good candidate for a transplant. They want to make sure the new liver has the best chance of working well for a long time.

Some reasons a person might not be able to get a transplant include:

• Having a serious illness, like an advanced cancer, that has spread outside the liver.
• Having a severe heart or lung condition that would make the surgery too dangerous.
• Having unhealthy habits that could harm the new liver.

Sometimes, a person who isn't ready for a transplant can become a good candidate later. For example, if they get healthier or treat other medical problems, they might be able to get on the waiting list for a new liver.

What Are the Risks?

Like any major surgery, a liver transplant has risks. One of the main challenges is called rejection.

Graft Rejection

Rejection happens when the body's immune system sees the new liver as a foreign object and tries to attack it, just like it would attack germs. This can happen at any time after the surgery. To prevent this, patients must take special medicines called immunosuppressants for the rest of their lives. These medicines quiet down the immune system so it won't harm the new liver.

There are three main types of rejection:

• Hyperacute rejection: This happens very fast, within minutes or hours of the surgery. It is very rare today because of careful matching before the transplant.
• Acute rejection: This is the most common type and usually happens within the first few weeks. It can often be treated successfully with medicine.
• Chronic rejection: This is a slower type of rejection that can happen over a long period of time.

Other Complications

Other problems can sometimes occur after the surgery. These might involve the blood vessels that connect to the liver or the small tubes (bile ducts) that carry a digestive fluid called bile from the liver. Doctors watch patients very closely to catch and treat these problems early.

How the Surgery Works

A liver transplant is a long and complex operation that can take many hours.

First, the surgeons make an incision in the upper abdomen to reach the liver. They carefully disconnect the sick liver from all its attachments and blood vessels. This part of the surgery is called the hepatectomy (liver removal).

Next, the healthy donor liver is put in the same place where the old liver was. The surgeons then carefully connect the new liver's blood vessels and bile duct. Once everything is connected, blood flows into the new liver, and it starts to work.

Most transplants use a whole liver from a donor who has passed away. However, there are other amazing techniques that allow more people to get the help they need.

Living Donor Liver Transplant

A living donor liver transplant is a special type of surgery where a healthy person donates a piece of their liver to someone in need. This is possible because the liver has an amazing ability to regrow!

In this procedure, surgeons remove a portion of the donor's healthy liver. The remaining part of the donor's liver grows back to its normal size in just a few weeks. The transplanted piece of liver also grows to the right size inside the person who received it.

This type of transplant is often used for children, where a parent can donate a small part of their liver to their child. It is a very demanding surgery for both the donor and the recipient, but it can save lives, especially since there is a shortage of donor organs.

Who Can Be a Living Donor?

A CT scan helps doctors check the blood vessels of a potential donor's liver to make sure the surgery will be safe.

A living donor must be a healthy adult, usually between 18 and 60 years old. They go through many tests to make sure they are healthy enough for the surgery and that their liver is a good match for the recipient. Donors are often family members, but they can also be close friends or even volunteers who want to help someone.

The most important thing is that the donor is in excellent health and is making the choice to donate for good reasons, without any pressure.

Life After a Transplant

In children, a smaller piece of a donor's liver, called a "split" liver transplant, is often used.

After a liver transplant, recovery takes time. Patients stay in the hospital for a while so doctors and nurses can monitor them closely.

As mentioned before, people who receive a new liver must take immunosuppressant medicines every day for the rest of their lives. These medicines are key to preventing rejection and keeping the new liver healthy.

With a successful transplant, many people can return to a normal, active life. The chance of living for many years after a transplant is good. Many people have survived for more than 15 years with their new liver.

History of Liver Transplants

The first attempts at liver transplants were done on dogs in the 1950s. The first human liver transplant was attempted in 1963 by a surgeon named Dr. Thomas Starzl. Sadly, the patient did not survive the operation.

Dr. Starzl and his team kept trying, and in 1967, they performed the first successful liver transplant on a young girl. She lived for more than a year after her surgery.

In the 1970s, the surgery was still very risky. But in the 1980s, a new medicine called ciclosporin was introduced. This drug was much better at preventing rejection, and it made liver transplants much more successful. Today, liver transplantation is a standard treatment performed at hospitals all over the world.

Famous People Who Had Liver Transplants

Many well-known people have had liver transplants. Here are a few examples:

• Eric Abidal (born 1979), French soccer player, transplant in 2012 (survival: 13 years)
• Gregg Allman (1947–2017), American musician, transplant in 2010 (survival: 7 years)
• George Best (1946–2005), Northern-Irish soccer player, transplant in 2002 (survival: 3 years)
• David Crosby (1941–2023), American musician, transplant in 1994 (survival: 29 years)
• Shelley Fabares (born 1944), American actress and singer, transplant in 2000 (survival: 25 years)
• Larry Hagman (1931–2012), American actor known for the TV show Dallas, transplant in 1995 (survival: 17 years)
• Steve Jobs (1955–2011), co-founder of Apple Inc., transplant in 2009 (survival: 2 years)
• Chris Klug (born 1972), American snowboarder who won an Olympic medal after his transplant, transplant in 2000 (survival: 25 years)
• Evel Knievel (1938–2007), American stunt performer, transplant in 1999 (survival: 8 years)
• Mickey Mantle (1931–1995), American baseball player for the New York Yankees, transplant in 1995 (survival: <1 year)
• Phil Lesh (1940–2024), American musician for the Grateful Dead, transplant in 1998 (survival: 26 years)