What to Expect If Your Child Needs a Liver Transplant

After Liver Transplant

Our goal in performing a liver transplant is for your child to grow and develop like other healthy children of the same age.

We encourage your child to engage in age-appropriate activities. We will work with you to adapt your child’s medical needs to a normal schedule and activities.

Liver Transplant Rejection

Organ rejection is a specific problem that can occur after transplant surgery. The new liver comes from another person, so your child’s immune system will recognize that the liver is different and may try to attack it. If your child’s immune system injures the liver, this is called rejection.

  • Preventing liver rejection

    The possibility for rejection is highest soon after transplant. But at any time your child’s immune system might try to reject the liver.

    For the new organ to function in your child’s body, we must give your child medicines that suppress their immune response. To prevent rejection, your child will need to take medicines as long as the liver is in place.

  • Types of liver rejection

    There are 2 types of rejection: acute and chronic. 

    • Acute rejection most commonly occurs within the first 6 months after transplant. It is not unusual to see a rejection episode 7 to 14 days after surgery. If your child has acute rejection, do not get discouraged. This is why we check your child so closely with lab work and other tests. If rejection is diagnosed, we will start IV steroids for several days. Other medicines can be used if this therapy does not work.
    • Chronic rejection occurs slowly over time. The liver develops scar tissue from the immune system, causing injury to the liver over a long time. Chronic rejection is very difficult to reverse. It can lead to liver failure. If this happens, your child will need another transplant. Our goal is to maintain liver function for as long as possible.
  • Diagnosing liver rejection

    If we think rejection is happening, we perform a biopsy – a procedure where we insert a needle into your child’s liver and take a tiny sample of tissue. Looking at the tissue under a microscope, we will be able to see if your child’s immune system is causing injury to the liver.

    Your child will be asleep for this procedure and might need to stay in the hospital overnight afterwards.

  • Treating liver rejection

    Rejection does not necessarily mean that your child will lose the liver. If detected early, most rejection episodes can be treated successfully.

    Treatment for rejection involves: 

    • Increasing the amount of medicine to suppress your child’s immune system
    • Allowing the liver to recover from the rejection injury 

    This usually includes increased steroid doses, but may also require other medicines.

Clinic and Follow-Up Visits After Liver Transplant

During the first year after the transplantation, your child will need to visit the Liver and Intestine Transplant Clinic at Seattle Children’s many times for follow-up visits and lab tests. To schedule appointments, contact the Liver and Intestine Transplant Clinic.

  • Typical schedule

    A typical schedule of post-transplant clinic visits and lab tests might be: 

    • Month 1:
      • Clinic visits 1 to 2 times a week
      • Labs 1 to 2 times a week
    • Months 2 and 3:
      • Clinic visits every other week
      • Labs 1 to 2 times a week
    • Months 4 through 6:
      • Clinic visits 1 time a month
      • Labs 2 times a month
    • Months 7 through 12:
      • Clinic visits 1 time a month
      • Labs 1 time a month
    • Year 2 and on:
      • Clinic visits 1 time a year
      • Labs every 3 months 

    These are general guidelines. Your actual schedule for follow-up visits and lab tests will depend on how your child is doing, how the liver is working and if your child has developed any other problems after transplant. If your child is having complications, visits may be more frequent.

  • Things to remember
    • We must be able to contact you at any time. We need to have current mobile, work and home phone numbers.
    • Your child will need lifelong medical and transplant follow-up – throughout childhood and into adulthood – to ensure the best liver function. We will continue to check for any transplant-related problems.
    • Your child’s transplant nurse coordinator or transplant nurse practitioner will act as your main contact at Seattle Children’s for any problems or questions.