A pediatric liver transplant is a surgical procedure in which a diseased liver in a child is replaced with a healthy liver from a donor (either living or deceased).

A Child may need a liver transplant with the conditions including Biliary atresia (most common in infants), Acute liver failure, Genetic/metabolic liver diseases (e.g., Wilson’s disease), Liver tumors (e.g., hepatoblastoma), Cirrhosis or end-stage liver disease. If medical treatment is no longer effective, a pediatric liver transplant may be necessary to save the child’s life.

There are two main types of pediatric liver transplants, such as:

Orthotopic liver transplant (OLT): Whole of the diseased liver is replaced with a healthy liver from a deceased or living donor.

Living donor liver transplant (LDLT): A portion of the diseased liver is removed and transplanted into the child, liver is a self-regenerating tissue, so the remaining portion will regenerate within few weeks.

Studies show remarkable long-term survival: about 70% - 80% of children are alive 20 years after transplant, and 60% - 70% grafts (transplanted livers) continue functioning well. Families should note that chronic complications—like mild liver dysfunction, kidney issues, or growth delays—can manifest over time, requiring ongoing follow-up.

Pediatric liver transplant isn't age-limited; rather, it prioritizes need over age. Children under 12 use the PELD system (Pediatric End-Stage Liver Disease), and teens age into the adult MELD system (Model for End-Stage Liver Disease). So, even older children and teens are eligible, as long as liver failure significantly impacts health and quality of life.

During a pediatric liver transplant, the team first confirms the child’s readiness, then moves them to the OR and administers anesthesia. The surgeon makes an abdominal incision to remove the diseased liver, then implants the donor liver or a portion of it. Blood vessels and bile ducts are connected, and once the new liver functions properly, the incision is closed. The surgery typically lasts 10–12 hours, with the team keeping the family updated throughout.

Overall success rates in children are excellent: 5-year survival after transplant is between 90% - 95% if the procedure occurs after age two. Early recognition of complications and advanced surgical care—as offered at Rainbow Hospitals—help maintain these high success rates.

Post liver transplant surgery, your child is monitored closely in the pediatric intensive care unit (PICU) for a few days with pain management and support. They then move to a transplant care unit for continued recovery. Hospital stays typically last 2–3 weeks, during which families learn how to care for the new liver. After discharge, regular follow-ups are essential to monitor liver function and overall health.

Pediatric liver transplant complications include:

• Primary graft failure (<10%) needing re-transplantation
• Vascular thrombosis (hepatic artery up to 25%) risking graft loss
• Biliary leaks or strictures (up to 35%) treated with drainage or surgery
• Acute rejection common; chronic rejection (~10%) managed with immunosuppressants
• Infections (CMV, EBV, PTLD) increased by immunosuppression
• Kidney injury, bleeding (up to 9%), thrombosis (up to 19%) require close monitoring
• Neurological issues (20%), like seizures, often linked to pre-transplant encephalopathy

Recovery after a pediatric liver transplant involves close monitoring in the ICU, followed by a stay in a specialized transplant unit. The child receives pain management, immunosuppressants to prevent rejection, and support for organ function. Hospitalization typically lasts 2–3 weeks, during which families learn liver care. After discharge, regular follow-ups and careful monitoring ensure successful healing and long-term health.

After a pediatric liver transplant, it’s important to watch your child carefully for signs of infection or rejection. These signs can include fever, tiredness, coughing, vomiting, weight loss, poor appetite, stomach pains, diarrhoea, or yellowing of the eyes or skin (jaundice).