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    • PEDIATRIC LIVER TRANSPLANT PROGRAM

    We are pioneers in liver transplant for pediatric patients in Puerto Rico,
    offering hope and specialized care to our patients and their families.
    Medical Faculty

    When does a child require
    a liver transplant?

    A liver transplant is considered when a minor (under 21 years of age)
    has a life-threatening liver-related illness that cannot be treated
    by other means.

    The most common cause for a liver transplant is biliary atresia, a
    deformity in the biliary tract that prevents bile from exiting the
    liver into the intestines.

    Other causes include:

    Fulminant Hepatitis

    Autoimmune liver diseases

    Viral Hepatitis

    Hereditary metabolic diseases

    Liver tumors, both benign (of a
    considerable size) or malignant

    It is important that parents and referring physicians understand
    that there are cases in which a pediatric transplant is
    not recommendable.

    Serious heart problems or other preexisting conditions

    Current or chronic infection that cannot be controlled

    Metastatic cancer (when cancer has
    reached other parts of the body)

    Other serious diseases that could not heal post-transplant

    If your child presents any of these health conditions, they may be a candidate for a
    liver transplant    . To initiate the process, they must be referred by their pediatric
    gastroenterologist to our Pediatric Liver Transplant Program, where they will
    undergo a medical and psychosocial evaluation to determine their eligibility.

    Evaluation Process

    Evaluations: Each child is evaluated by a multidisciplinary team that includes a hepatologist, transplant surgeon, psychiatrist, social worker, dietitian, pharmacist, cardiologist, infectious disease specialist, dentist, among other specialists on a case by case basis.

    Blood tests: They are carried out in order to better understand liver function, detect possible infections, establish compatibility with possible donors, and calculate each patient’s priority on the waitlist.

    Diagnostic studies: They may include X-rays, ultrasounds, echocardiograms, and other tests according to each clinical condition.

    Case review: Once all evaluations are completed, each case is presented to the Selection Committee.

    SELECTION COMMITTEE

    This committee is made up of a transplant coordinator,
    pediatric hepatologist, transplant surgeon, social worker,
    financial coordinator, dietitian, psychiatrist and pharmacist
    – those who have participated in the evaluation.

    The purpose of this committee is to review all medical and social
    information in order to decide whether a transplant would be safe
    and beneficial to the patient and coherent with medical and
    psychosocial criteria previously established.

    Not all children are compatible with a liver transplant.
    Some of the most common reasons why this may be true are:

    Serious diseases that could not heal post-transplant

    Current or chronic infection that cannot be controlled

    Metastatic cancer (when cancer has reached
    other parts of the body)

    Waitlist and
    Liver Assignment

    Waitlist: In order for a child to be evaluated, the parents must visit the Hospital Auxilio Mutuo Pediatric Liver Transplant Program. If accepted, they are placed on the waitlist and their medical information is submitted to UNOS (United Network for Organ Sharing), the organization in charge of the national organ donor waitlist and their administration.

    Demographic data, diagnosis, and clinical outcomes are included to calculate a score called PELD (Pediatric End-Stage Liver Disease) in children under 12 years old, or MELD (Model for End-Stage Liver Disease) in adolescents. This score measures the gravity of a disease: the higher the score, the higher the patient’s priority.

    If the score does not accurately represent the child’s condition, the team may request an exception in order to alter it.

    It is important that the patient remain active in the list, performing periodic laboratories and medical evaluations and maintaining consistent communication with the transplant coordinator. This ensures that the patient’s medical information is up to date and that the child retains their place on the waitlist.

    Liver Assignment: When an organ becomes available, UNOS considers the medical urgency, blood type, organ size, and the distance between the donor’s hospital and the patient.

    When there is a possible donor for your child, our team will reach out to your family immediately. If your child is not hospitalized, they must be taken to the hospital as soon as possible in order to prepare the child for the transplant surgery.

    Postoperative Care
    and Recovery

    Hospitalization after a transplant: After the transplant surgery, the patient is typically hospitalized for around 10 days with intensive monitoring. In some cases, especially in the case of young infants, this may be extended to a period of about two to four weeks, depending on their medical progression.

    Follow-up after a transplant: Once the child’s liver function has been stabilized, they are discharged, but under strict observation, especially during the first few months, during which the patient’s treatment is adjusted according to their response to it. During the first year, it is imperative to prevent infections and potential rejection, in order to ensure a stable long-term recovery.

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