Liver Transplant

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When does a liver transplant indicated in a neonate.One of my babies will go for an expert opinion for the same within few days.he is a postNEC case with multiple necrosed sites with adown pouring jejunostomy.feeds are ot tollerated ,mother is the donar most probably. but I am hearing about Liver trans for the first time.Can you share with me?

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Specializes in NICU, PICU, educator.

We've had a few kids evaluated, but it was usually in conjunction with a gut transplant. Their livers are usually shot from being on HAL for so long.

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Specializes in Neonatal ICU (Cardiothoracic).

What BittyBabyGrower said.... I've only seen a few evals done, and none qualified. The evals I've seen were for an invasive hepatic hemangioma, and hepatic failure due to extended hyperalimentation.

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Specializes in women's health, NICU.
We've had a few kids evaluated, but it was usually in conjunction with a gut transplant. Their livers are usually shot from being on HAL for so long.

I'm sorry this is probably a dumb question, but what is HAL??

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Specializes in PICU, ICU, Transplant, Trauma, Surgical.
I'm sorry this is probably a dumb question, but what is HAL??

I believe they were referencing hyperalimentation or TPN/IL. TPN is sooo bad for livers when used long term, I've seen lots of kids' livers go bad, but there were other disease processes going on and they were not candidates for xplant.

It would be interesting to see what the indication is. I'm guessing this is an older kid?

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Specializes in NICU.

From what I've read some short-gut kids (be it from NEC or something like Hirschprung's) end up needing both livers (because of the TPN) and guts, but since guts are much harder to come by and they're not done by as many people, sometimes they just go ahead and do the liver to keep the kid alive until a gut is feasible.

I've also seen/read about livers getting shot by some sort of ischemic event. I just had a kid in for a heart transplant eval 2/2 dilated cardiomyopathy who had crazy LFTs. And a meconium/PPHN kid with an AlkPhos over 1100! :eek:

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Specializes in NICU, PICU, educator.

We have sent kids to CHOP and they will usually only do the two together since they have a better outcome, so it is pretty rare for that type of transplant since baby donors are pretty rare. There is such a long list for this, we have flown kids there to be eval'd and put on the list, but they die before it can happen :(

I think ischemic events go hand in hand with bad gut and livers, esp in full termers, and that is just heart breaking :(

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