The Children's Hospital of Philadelphia
www.chop.edu
Our Liver Transplant Program — At the Hospital: Surgery and Post-Operation

Narrator: When you go to the hospital, go to the Admissions Office on the 1st floor of the main building or to the Emergency Department if it's after midnight. Once you've been admitted, you will be taken to a room on a patient unit. An intravenous line, or IV, will be placed in your child. This is for antibiotics and other medications. Blood will be drawn for testing, and a urine sample will be taken. X-rays will also be taken. The anesthesiologist is the doctor who will make sure your child sleeps through surgery and has no pain. The transplant surgeon or surgical resident will perform a physical exam on your child so that they have the clearest possible picture of your child's health. They will review the surgical procedure with you and answer any questions you may have. They will ask you to sign the consent forms for the anesthesia and the surgery; standard procedure before any operation.

The surgical team consists of anesthesiologists, surgeons, registered nurses, and technicians. The call to go into the Operating Room will come 1 hour before the surgery starts so that the anesthesiologist and nurses can prepare your child. Sleep medication will be delivered through the IV line. Once your child is deeply asleep, the team will attach the lines and catheters they need to monitor urine output, blood pressure, pulse rate, temperature, and breathing. Blood and blood products such as platelets and plasma may need to be given during the operation.

The surgeon will begin the procedure by cleaning your child's skin. Drapes will be used to protect the area. An incision will be made in the shape of a frown or an upside down "Y". The diseased liver will be removed, and the healthy liver will be sewn into place by the surgeon.

The actual liver transplant may take 5 to 8 hours plus the time needed by the anesthesiologist. Liver transplant for a child is a very complicated procedure, so it's hard to say exactly how long each transplant will take.

After the operation is over, your child will move to the Pediatric Intensive Care Unit, or PICU. You will be asked to wait while nurses and physicians get your child settled in. The staff in the PICU will monitor your child's heart rate, breathing rate, blood pressure, and oxygen level. IV pumps will be in place to supply fluids and medications. Some have alarms that may go off. The nurses will check your child and the equipment when this happens.

A tube will be in place in either your child's nose or mouth to help with breathing after surgery. Your child will not be able to talk, eat, or drink with the tube in place but will able to write on a pad or use hand signals. This tube may be removed in the operating room or soon after.

Other tubes and drains will be put into place during surgery. They help to drain excess fluids that result from the operation. Some of these will be removed on the first or second day after surgery. A Foley catheter will be in place to drain urine from the bladder and to monitor kidney function. A Broviac catheter may be inserted in a large vein in the neck. It can be used to give medications and IV fluids or to draw blood. Some children may go home with a Broviac catheter in place for giving IV medications. If so, you will be taught how to care for it.

This time immediately after the surgery is a time for testing and monitoring your child's condition. Blood tests will be done daily. Chest X-rays will be used to assess your child's lungs. An ultrasound will check the proper flow of blood to the new liver, a primary concern after surgery. Sometimes complications occur such as infection, bleeding, or the need for re-operation or re-transplant. Be assured that everything possible will be done to assure a successful outcome and a complete recovery.

Once your child is stable and doesn't require intensive monitoring, they will be transferred from the PICU to a surgical unit. The surroundings will be quieter, and you can start thinking about some of the things you can do to help your child during recovery. Walking around the room or down the hallway helps to build strength and activity. Your nurse will help you with coughing and deep breathing exercises. As the recovery progresses, your child will advance from clear liquids to solid foods. The body needs well balanced meals to heal and grow. As your child feels better, it will be important to relax and play, to have fun, and start to feel normal again. The Child Life Specialist will help with the emotional part of the recovery process.