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A pediatric liver transplant is a surgical procedure in which a healthy liver or part of a healthy liver from a donor is transferred into a child with severe liver disease. This is generally done when a child's liver is degenerating and no longer performs as it should, often due to acute liver failure, metabolic defects, or biliary atresia.

When acute or chronic liver illness causes a child's liver to stop functioning normally, a pediatric liver transplant is done. Biliary atresia, acute liver failure, metabolic liver illnesses, and genetic disorders are among the common situations that result in transplantation. In order to encourage growth and development, restore normal liver function, and avoid potentially fatal consequences like liver failure, severe jaundice, internal bleeding, and infections, the damaged liver will be replaced with a healthy donor liver.

Parents should seek medical attention if a child shows signs of liver dysfunction, including jaundice (yellowing of the eyes and skin), swollen abdomen, chronic vomiting, poor appetite, dark urine, pale stools, frequent bruising, or poor weight gain. If liver disease is diagnosed, ongoing evaluation by a pediatric hepatologist or liver transplant team is essential. Early referral improves the success and outcomes of transplant planning.

Preparation includes a comprehensive medical evaluation, lab tests, imaging (ultrasound, CT, MRI), liver biopsy (if required), and psychological assessment of the child and family. The transplant team evaluates nutritional status, organ function, and suitability for surgery. Once listed for transplant, the child waits for a compatible deceased donor or living donor liver. Preoperative care also involves infection screening, vaccination updates, and counselling about the procedure, recovery, and lifelong care needs.

The surgery is performed under general anaesthesia and may last 6 to 12 hours, depending on the child’s condition and the complexity of the transplant.

Donor Types:
- Living donor: A portion of liver from a healthy adult, often a parent or relative. The liver regenerates in both donor and recipient.
- Deceased donor: A whole or partial liver from a brain-dead donor.
Procedure:
The diseased liver is surgically removed and replaced with the healthy donor liver. Blood vessels and bile ducts are carefully connected to ensure normal circulation and bile drainage.

The transplant surgery itself takes 6–12 hours. Postoperative intensive care is usually required for 2–5 days, followed by a hospital stay of 2–4 weeks, depending on the child’s recovery, complications (if any), and nutritional status.

Organ rejection
Bleeding
Infection
Bile duct complications (leaks or narrowing)
Blood clots
Side effects of immunosuppressants
Delayed graft function or graft failure

Reversal of end-stage liver disease
Improved growth, energy, and appetite
Normalisation of metabolic and liver functions
Drastic reduction in disease-related hospitalisations
Restoration of a normal or near-normal quality of life

Recovery includes close monitoring in ICU, infection prevention, and initiation of immunosuppressive therapy to prevent organ rejection. The child will gradually resume feeding and physical activity. Long-term follow-up includes regular lab tests, imaging, and medication management. Schooling and routine life often resume in a few months, with ongoing care from a transplant team.

Pediatric liver transplant has an excellent success rate, with 1-year survival rates over 90% and 5-year survival around 85–90% at experienced centres. With timely surgery, proper medication, and consistent follow-up, most children go on to live healthy and active lives.