If you need to contact the transplant unit before you arrive (night or day), call 612-273-3000 . Ask for the Solid Organ Transplant Unit.

If your child is having a deceased donor transplant

If your child is having a living donor transplant

The liver transplant operation

Possible surgical complications

Recovering in the hospital 

How long will your child have to be in the hospital?

If your child is  having a deceased donor transplant
If your child will receive a liver from a deceased donor, you will get a call from a doctor at the University of Minnesota Amplatz Children's Hospital. Calls like this often come at night, so be sure to answer your phone.

The doctor will ask you to bring your child to the hospital as quickly (and safely) as possible. Please be sure to:

• Get the doctor’s name and phone number.
• Ask the doctor if your child should stop any of his or her medicines. If your child takes insulin for diabetes, ask what to do about the insulin.
• Stop all foods and liquids. If your child has taken insulin, he or she may eat hard candy or drink glucose fluids (juice, regular soda pop) to prevent low blood sugar.

Once you arrive at the hospital, please stop at the Admissions Department. They will know you are coming and will direct you to the Transplant Unit. Once your child is admitted, we will prepare your child for surgery.

• Your child will have a chest X-ray, ECG, blood tests and urine tests.
• You child may need enemas to clean out the intestines.
• Your child will be told how to take a shower using special soap, if they are old enough. Otherwise, you can bathe him or her.
• The doctor in charge of your child's anesthesia (anesthesiologist) will do a brief exam.
• We may insert an IV (intravenous) line to give your child fluids and medicines.

Your family can stay with your child until it is time to go to the operating room. We will then direct them to the waiting area on the third floor. After your surgery, the doctors will meet them there.

If you are having a living donor transplant
If your child will receive a liver from a living donor, we will give you a date for your child's surgery.

The day before surgery, you will bring your child to the Transplant Center for a physical exam. This will include blood tests, chest X-rays and an ECG. We will also teach you how to get your child ready for the surgery.

The day of surgery:

• Please arrive at 5:30 a.m.
• Go to the Same Day Admission Unit (3C) at the University of Minnesota Children's Hospital.
• Please have your child remove glasses, nail polish, lipstick, makeup, jewelry and hairpins. Leave your valuables at home, with Security or with your family for safekeeping.
• We will insert an IV (intravenous) line. This allows us to give your child fluids and medicines during the surgery. The doctor in charge of your child's anesthesia medicine (the  anesthesiologist) will also come to see you and your child. 

You and your family can stay with your child until it is time to go to the operating room. We will then direct you to the waiting area on the third floor. After your child's surgery, the doctors will meet you there.

The transplant operation
A liver transplant is very complex. The average surgery takes six to 10 hours to complete. The surgeons must isolate the major blood vessels and bile duct of your child's liver and attach the “new” liver to the same vessels. They will remove the old liver and gallbladder.

The surgery is long because removing the diseased liver can be difficult. If your child has had other surgeries, there may be scar tissue that causes tissues to stick together. Also, poor clotting can cause bleeding. Your child may receive blood products (a blood transfusion) to make up for this loss. Your child's incision will be in the upper abdomen, just under the rib cage.

While most patients come in with a swollen spleen, this is rarely removed during the surgery. The spleen may get smaller in the weeks after the transplant. Your child's spleen helps to maintain a good blood flow through his or her new liver. It is only removed when it causes problems or when your chidl's liver donor has a different blood type.

After your child's new liver is in place, the surgeons will watch for signs that it is healthy and has a good blood supply. One of the surgeons may update your family at this time about possible surgical complications:

• Bleeding: Bleeding is a major concern during and right after surgery. A blood transfusion will be given if needed. Your child may need to go back to surgery to correct further bleeding.
• Breathing problems: The liver, lungs and diaphragm are located close to each other. For this reason, fluid build-up as well as short-term swelling in the new liver can make it hard to breathe deeply. Your child will receive medicine to help prevent pain and to keep him or her relaxed. Your child will need the help of a breathing machine (respirator) until he or she can breathe without help.
• Infection: The drugs used to prevent rejection may limit the body’s ability to fight infection. We will give your child antibiotic (germ-fighting) medicine before and after surgery. We will test your child often for early signs of infection.
• Obstruction (blocked vessels): Your blood vessels or bile ducts may become blocked right after surgery. This may slow the flow of blood or bile to and from your child's new liver. We will do ultrasounds after surgery to check the blood flow.
• Kidney damage: Your child may have kidney problems after surgery. These may be short-term or lifelong and have a number of possible causes. Sometimes liver disease can affect the kidneys. At other times, anti-rejection drugs may affect kidney function. For some people, the blood flow from the kidneys is disrupted during surgery, causing the kidneys to function poorly for several days. (In this case, kidney function will often improve over time.) Some people need dialysis for a time after surgery.

We will watch your child's urine output and do blood tests to check your child's kidneys. Your child may have a tube in his or her bladder (a urinary catheter) for several days until your child's fluids and kidneys are stable.

Recovering in the Hospital
After your child leaves the operating room, he or she will be taken to the Pediatric Intensive Care Unit (PICU) on 5C. Your child will stay there until he or she is stable and able to breathe without help. One parent is allowed to stay overnight at your child's bedside. The other parent can sleep in the family lounge. Visiting hours for others are limited. Please ask your nurse for more information.

Your child may be slow to wake up after surgery. We may give your child medicine to control pain and help him or her relax. You will find that many tubes were placed in your child's body during surgery.

• Endotrachial (breathing) tube: Your child will have a tube in his or her throat to help with breathing. It may be uncomfortable, but we will give your child medicine to help him or her relax. Your child cannot talk while the tube is in the mouth. The doctors will remove the tube as soon as your child can breathe on his or her own.
• Biliary stent (tube): This tube is placed in your child's bile duct at the time of surgery. It allows bile to flow freely while the stitches in your child's bile duct heal. Your surgeon will decide when to remove the stent. There are two kinds of biliary stents:
  – An external stent comes out the front of the abdomen. It drains bile into a small plastic bag. The bile often looks golden or dark green.
  – An internal stent is placed inside your child's body at the site where your child's new bile duct connects with the old one. It allows the tissue to heal without scarring and blocking bile flow.
• Jackson-Pratt (JP) tubes: These help drain the extra fluid and blood from the surgical area in your child's abdomen. They are attached to soft plastic bulbs that provide gentle suction. Your child may be sent home with one of these drainage tubes. We will tell you how to care for it. We will remove the tube during one of your child's follow-up visits.
• Chest tube: In rare cases, a tube may be placed in your child's lungs to help drain fluid. This is temporary.
• Foley catheter (urinary tube): This tube will be in your child's bladder for a number of days until your child's fluids and kidneys are stable. It allows the nurses to check your child's urine output.
• Intravenous (IV) lines: Your child will have many IV lines, including a “central line.” This tube is placed in a large vein near the heart. We use it to give medicines, fluids and blood transfusions. It is also used to take blood samples and check fluid pressures in the body. Your child may have this until the day he or she leaves the hospital.
• Nasogastric (NG) tube: This helps keep your child's stomach empty so he or she doesn't get nauseated (feel sick to the stomach). During surgery, the tube is placed in the nose and goes down into your child's stomach. It will stay in place until your child can pass gas and have bowel  movements. Your child cannot eat while he or she has an NG tube.
• Compression sleeves: Your child may have compression sleeves. These surround your child's lower legs. They will inflate and deflate every so often. This helps blood flow and prevents blood clots. Once your child can get up and walk, he or she will not need them anymore.

 
Once your child is stable and the breathing tube has been removed, we will move your child to Unit 5A or 5B. Your child may be in a single or double room. We will draw blood tests daily, usually through the central line. Your child may also have X-rays and a liver biopsy to make sure the liver is working well.

While your child is on the Transplant Unit, you will learn about your child's medicines and how to take care of your child at home. You will need to go to two different classes. Your child's nurse will schedule these for you. You will also receive a handbook for patient families. This provides general information and a place to write your child's lab results.

Your nurse will work closely with you as you learn. By the time you go home you will know how to give your child his or her medicines, record your child's lab values, check your child's blood pressure and more. Once you take your child home, you will need to keep track of your child's lab values and report them to the transplant office until your child is able to do it on his or her own. This needs to be done for the rest of your child's life.

How long will you have to be in the hospital?
Your child will be in the hospital for about two weeks. Some children stay as long as two months. Once you have attended the classes and know how to care for your child, you will leave the hospital.