Pediatric liver transplantation in India: all you need to know about liver injury in children?

New Delhi: It is said that in India, about 2 people die from liver failure and 50,000 others from liver cancer. Of these, 40,000 to 50,000 can be saved by a liver transplant. However, according to experts, only 1,600 to 1,700 liver transplants are performed each year (2017-2018) in India, mainly because of the lack of donors. The lack of awareness of the general public about liver disease, especially in children, often leads to late diagnosis or forgotten, as well as a lack of access to appropriate treatment options.

The deceased donor organ donation rate is expected to reach at least 20-22 / million in India, which would represent about 30,000 donors annually. However, it is only about 0.55 per million, i.e. approximately 700 donors / year between 2015-2017. By comparison, in the western United States, the number of deceased donors is 24 percent in the United States and 38 percent of deceased donors in Spain each year. Dr. Arvinder Singh Care, President, Institute of Liver Transplantation and Regenerative Medicine, Medanta The Medicity, Gurgaon, teaches us some important facts about pediatric liver transplantation in India. Continue reading! Read – Liver Disease: Pay attention to these 10 early signs that can damage your liver

What are the conditions that cause liver damage in children?

Extrahepatic biliary atresia (AHBA) is the most common cause of liver injury in children. It causes biliary lesions of the liver from birth due to the accumulation of bile in the liver. This also causes cirrhosis of the liver. This leads slowly and eventually to liver failure in the child. EHBA is responsible for 60% of cases of hepatic impairment in children. This condition occurs in 1/15 000 children.

The other cause of liver disease in children is metabolic abnormalities of the liver, due to abnormal enzymes made in the liver. When the metabolic cycle through which toxic substances are eliminated and nutrients are absorbed, they begin to malfunction. This leads to the formation of abnormal products in the liver, resulting in liver damage and cirrhosis. Metabolic abnormalities of the liver are responsible for 35% of cases of hepatic impairment in the child. This condition is also referred to as PFIC of progressive familial intrahepatic cholestasis. The remaining 5% is due to various causes.

What are the signs and symptoms to understand if the child has liver disease? What types of tests are required to detect the disease?

In children, often with chronic liver disease:

• They face stunting or stunting, which means that the child will be weak and will not accept it orally, which will cause a drop in appetite.
• Their weight and growth in height will not be suitable for ages

In addition, they could have:

• Anemia (low hemoglobin level)
• Jaundice
• Belly distended with water
• Bleeding in their vomit and stool

Tests such as hepatic function test (LFT), prothromintime, ultrasound, and abdominal CT scan are standard tests to reveal liver abnormalities. Read – Beware, this common badgesic can cause acute liver failure

Of the total number of liver transplants, what is the percentage of pediatric liver transplant?

The percentage of pediatric liver transplants in India is about 10%.

Does the size of the baby have an impact on the transplant?

Yes, if the baby is small (or less than 10 kilos), the transplant becomes very complex. Generally, the parts of the liver that are removed from the donor to be transplanted are either the right side or the left side, or a small portion of the left side called the left side. The left side of an adult is too big for a baby under 10 pounds. Surgeons must reduce the size of these pieces of liver to fit the child's liver. This process calls for a reduced draw of the liver. The surgeon must have enough expertise to understand how the liver can be reduced so that its functionality remains. It is important to perform a transfusion-free surgery because the body of the child is too small to withstand blood loss. IVF (intravenous fluids) should be carefully performed to avoid cardiac congestion or to cause fluid disruption. The anesthesia and surgery team must be very experienced and careful in performing these surgeries.

Can an older person give liver to a child? If so, what are the criteria to be taken into account?

All living donors are people between 18 and 55 years old. Corpse donors (people who are either brain dead or who are functioning but who have died) can be children or adults. Living people are always adults. Hospitals are never part of the liver of live children.

The criteria for making a donation are:

• The donor must be 18 to 55 years old
• The blood group must match, that is, the same group or blood group O
• The donor must come from the family.
• The donor should not be obese overweight.

What are the postoperative problems / complications that children face and how can they overcome them?

On the bright side, depending on the success rate, 95-97% of children are doing well and returning home after the operation. The remaining 3 to 4% includes some of the others who have problems with rejection, infection, bleeding and bile leakage, but who are finally successfully evacuated. It is rare that a patient will not succeed.

Patients can have long-term effects. Adults / adolescents may have a compliance problem as they may not take their medications properly. It is important that medications are followed correctly and that tests are performed regularly. Medications have very occasional side effects. In most cases, there are no long-term side effects or uncontrollable complications by the doctors to treat.