Paediatric liver transplantation is a treatment pathway for selected children with severe liver disease or other conditions in which transplantation is considered appropriate. The supplied pediatric source identifies advanced liver disease, acute liver failure, selected metabolic disorders and certain liver tumours or congenital conditions as potential indications.
Children with progressive or advanced liver disease may need transplant evaluation when other treatment is no longer sufficient.
Severe acute liver failure may require urgent assessment by a specialist transplant team.
Some metabolic or genetic disorders, liver tumours and congenital conditions may warrant transplant assessment in appropriately selected children.
The indication and timing for transplantation are individualised. The treating specialists consider the child’s clinical condition and available treatment options.
A condition affecting bile flow that can lead to progressive liver damage and may require transplant evaluation.
Some inherited disorders may require transplantation when they cause severe liver dysfunction or other serious consequences.
Severe and rapidly developing liver injury may require urgent specialist evaluation.
Progressive chronic liver disease may lead to planned assessment for transplantation.
Certain liver tumours may warrant transplant evaluation when clinical criteria are met.
Some congenital liver-related conditions may be considered after specialist assessment.
The evaluation establishes the diagnosis and disease severity, assesses transplant readiness and identifies investigations or care needs before surgery. The exact work-up depends on age, diagnosis, previous surgeries and the proposed graft.
Living-donor transplantation may be an option for selected children. A deceased-donor liver may also be considered, and a split-liver graft can sometimes provide a smaller graft for a child. Suitability and availability depend on the clinical circumstances and applicable allocation requirements.
A suitable adult may be assessed to donate a portion of the liver. Donor safety, consent and graft suitability are central considerations.
A deceased-donor liver may be allocated through the applicable donation and allocation pathway.
In selected circumstances, a deceased-donor liver may be divided to provide grafts for more than one recipient, including a child.
A proposed donor undergoes a separate medical, anatomical and psychosocial assessment. Depending on the transplant team’s protocol, this may include:
The exact sequence and duration vary according to the child’s diagnosis, disease severity, donor pathway and clinical circumstances.
Review the child’s condition, medical history, reports and current treatment.
Complete the clinical and diagnostic assessments recommended by the team.
Discuss suitability, donor or graft options, risks and preparation.
Provide surgical and perioperative care according to the individual plan.
Monitor graft function, complications, feeding, medicines and rehabilitation.
Continue long-term monitoring, medication management and child-specific care.
Hospital stay depends on the child’s condition before surgery, graft function, feeding progress and recovery. The following are preliminary planning estimates and must be confirmed by Ruby Hall Clinic’s transplant team before publication.
| Stage | Preliminary planning estimate | Important context |
|---|---|---|
| Child’s PICU/ICU stay | Approximately 5–7 days or longer | Depends on clinical stability and recovery. |
| Child’s total hospital stay | Approximately 14–16 days or longer | May be longer if additional treatment or monitoring is needed. |
| Living donor’s hospital stay | Approximately 5–7 days | Depends on donor recovery and the treating team’s assessment. |
Ask the hospital for a written, itemised estimate before admission. Use this checklist to clarify what is included, what is excluded and how additional days or complications are billed.
| Package item | What the family should confirm |
|---|---|
| Donor evaluation | Consultations, tests, imaging and clearances included. |
| Child evaluation | Consultations, investigations, imaging and pre-transplant assessments. |
| Surgery and operating room | Surgical, anaesthesia, theatre and standard consumable charges. |
| Child’s PICU/ICU and ward stay | Included days, room category and additional-day charges. |
| Donor hospitalisation | Included stay, room category and extra-day charges. |
| Medicines and consumables | Which medicines and consumables are included or excluded. |
| Nutrition and feeding support | Dietitian services, specialised feeds and formula where relevant. |
| Blood products | How blood products and related charges are billed. |
| Post-transplant follow-up | Consultations, laboratory tests, medicines and any included follow-up period. |
| Complications or readmission | Exclusions, complication-related costs and readmission policy. |
Transplantation is the beginning of long-term care. Children need regular monitoring of graft function, prescribed medicines, nutrition, growth, development and other health needs.
Most transplant recipients need long-term immunosuppressive medicines and regular tests. Medicines should not be stopped or changed without instructions from the treating team.
Feeding, nutrition and healthy growth remain important parts of pediatric post-transplant care.
The team provides individual guidance on infection risks, vaccination, hygiene and when to seek medical advice.
Follow-up considers the child’s development and general health, with transition planning as the child approaches adult care.
MBBS · DNB (General Surgery) · Fellowship in Liver Transplantation, Global Hospital, Chennai
Dr. Manoj Shrivastav is a liver transplant surgeon at Ruby Hall Clinic, Pune, and currently leads the multi-organ transplant programme. He has personally completed over 200 liver transplants in Pune, 100 of them in the past year alone, with a survival rate above 95% and a one-year survival rate of 92% across his transplant series.
He is equipped to handle acute surgical emergencies and trauma across a variety of scenarios, has performed major liver resections for hepatocellular carcinoma and cholangiocarcinoma, and believes a successful transplant depends on excellent teamwork across the entire clinical team — not one surgeon alone.
Meet the TeamA transplant may be considered for acute liver failure, advanced chronic liver disease, biliary atresia, selected metabolic or genetic disorders and certain liver tumours or congenital conditions. The decision depends on the child’s diagnosis, severity and specialist assessment.
A parent may be assessed as a potential living donor, but suitability cannot be assumed. The proposed donor needs independent medical, anatomical and psychosocial evaluation.
Assessment may include blood tests, disease-severity and nutrition assessment, imaging, infection screening, anaesthesia review and heart or lung tests when indicated. The exact work-up depends on the child and the proposed transplant.
In selected circumstances, a deceased-donor liver can be divided to provide appropriately sized grafts for more than one recipient. The transplant team determines whether this option is clinically suitable.
The stay varies. Preliminary estimates for this page are around 5–7 days or longer in PICU/ICU and around 14–16 days or longer in hospital overall. Ruby Hall Clinic must confirm these estimates before publication.
A preliminary planning estimate is around 5–7 days, but the actual stay depends on donor recovery. Ruby Hall Clinic must confirm this estimate before publication.
Ask for an itemised estimate covering donor and child evaluation, surgery, critical care, ward stay, medicines, consumables, nutrition, blood products and follow-up. Confirm exclusions and the policy for additional days or complications.
Most transplant recipients need long-term immunosuppressive medicines and regular monitoring. The treating team will explain the medication schedule, tests and infection precautions.
No. Genetic or metabolic evaluation may be recommended when the suspected diagnosis or clinical history indicates it.
Return to school and travel depend on recovery and the transplant team’s advice. Families travelling from another city should arrange travel only after the treating team confirms that it is appropriate.
If your child has advanced liver disease or you have been advised to explore transplantation, speak with the hospital’s clinical
team about diagnosis, available options, required investigations and next steps.