Biliary Atresia — The Most Common Indication
Biliary atresia is a condition present from birth in which the bile ducts — the tubes
that carry bile from the liver to the intestine — are absent, blocked, or damaged.
Without functioning bile ducts, bile accumulates in the liver causing progressive damage
and cirrhosis. It is the single most common reason children require a liver transplant
in India.
Initial treatment is the Kasai procedure (portoenterostomy) — a surgical procedure that
creates a new bile drainage route. When the Kasai procedure fails or is performed too
late, liver transplantation becomes necessary, ideally before irreversible damage
occurs.
Other Common Indications in Children
- Alagille Syndrome — a genetic disorder causing abnormal bile duct
development and progressive liver disease
- Progressive Familial Intrahepatic Cholestasis (PFIC) — a group of
genetic disorders causing bile build-up and liver damage
- Wilson's Disease — genetic copper accumulation causing liver
failure, often presenting in older children and teenagers
- Acute Liver Failure in Children — sudden liver failure from viral
infections, drug reactions, or autoimmune hepatitis
- Autoimmune Hepatitis — the immune system attacks liver cells,
causing progressive damage
- Metabolic Liver Diseases — conditions such as alpha-1 antitrypsin
deficiency, glycogen storage diseases, and tyrosinaemia
- Hepatoblastoma — liver cancer occurring in very young children,
where transplant may be curative
Types of Paediatric Liver Transplant
Living Donor Liver Transplant for Children
The most common type of paediatric transplant in India. A parent or close relative
donates the left lateral segment of their liver — a smaller portion amounting to
approximately 20–25% of the adult liver — which is perfectly sized for a child
recipient. Both the donor's remaining liver and the transplanted segment regenerate to
appropriate sizes within weeks.
Living donor transplant offers the advantage of planned, timely surgery — critical for
children with deteriorating liver function — and avoids the uncertainty of deceased
donor waiting times.
Deceased Donor Liver Transplant for Children
When no suitable living donor is available, children are listed on the NOTTO (National
Organ and Tissue Transplant Organisation) paediatric waiting list, which prioritises
children over adults in many cases. Deceased donor organs may be used whole (for older
children) or split — with one portion going to a child and the other to an adult.
Split Liver Transplant
A split liver transplant divides a single cadaveric (deceased donor) liver into two
portions, allowing two recipients — typically an adult and a child — to benefit from a
single donated organ. This increases the overall pool of organs available for paediatric
patients.
Signs Your Child May Need a Liver Transplant
Parents should seek urgent specialist evaluation if their child shows any of the
following:
- Persistent jaundice after the newborn period — yellow skin or eyes that do not
resolve
- Pale, chalky, or grey-coloured stools in a newborn — a key warning sign of biliary
atresia
- Abdominal swelling or a noticeably enlarged liver or spleen
- Poor feeding, failure to thrive, or unexplained weight loss
- Excessive fatigue, lethargy, or developmental delays
- Recurrent fever or infections
- Easy bruising or unexplained bleeding
- Confusion, irritability, or behavioural changes — potentially indicating hepatic
encephalopathy
For Newborns: If your newborn has jaundice that persists beyond 2 weeks
of age AND pale stools, please seek immediate paediatric liver
specialist evaluation. Early diagnosis of biliary atresia and prompt Kasai surgery
(before 60 days of age) significantly improves outcomes.
Pre-Transplant Evaluation for Children
A thorough pre-transplant evaluation ensures your child is optimally prepared for
surgery and helps identify any additional medical issues that should be addressed
beforehand. Our multidisciplinary team takes special care to minimise risk and maximise
the chances of a smooth recovery.
- Blood tests: Full blood count, liver function tests, coagulation
screen, and blood group typing
- Infection screening: Viral hepatitis panel (HBV, HCV), CMV, EBV,
and immunological panel
- Abdominal ultrasound with Doppler: Assesses the liver, portal vein,
and spleen
- CT or MRI abdomen: Detailed imaging for surgical planning and liver
volume assessment
- Cardiac evaluation: ECG and echocardiogram to ensure the heart is
healthy for surgery
- Nutritional assessment: Many children with liver disease are
malnourished. Optimising nutrition before transplant is essential for healing and
recovery.
- Developmental & psychological assessment: Evaluation of the child's
development and psychological readiness, as well as family support systems
- Vaccination review: Ensuring all recommended childhood vaccinations
are up to date before transplant
Life After Paediatric Liver Transplant
Recovery & Returning to Normal Life
-
Hospital stay: Most children are discharged from hospital within
14–21 days of surgery
-
Return to school: Typically 2–3 months after transplant
-
Physical activity: Gradually resumed over 3–6 months; most children
can participate in sports
-
Growth and development: Children who receive timely transplants
typically achieve normal growth and developmental milestones
-
Immunosuppression medications: Required lifelong — managed as a
daily routine, similar to vitamins
Long-Term Outcomes
The long-term outcomes for paediatric liver transplantation have improved remarkably.
The vast majority of children who receive a liver transplant go on to live full,
healthy, active lives — attending school, playing sports, making friends, and achieving
their potential. With proper follow-up and medication adherence, a transplanted liver
can last for decades.
- 1-year graft survival rate: 85–90%
- 5-year patient survival rate: 80–85%
- Long-term quality of life: Comparable to the general paediatric
population in most patients
