Paediatric Liver Transplant in Kolkata

Key points

Biliary atresia is the most common reason for liver transplant in children, followed by inherited metabolic diseases and acute liver failure.
Most children in India receive a living donor graft, usually the left lateral segment of a parent's liver — a small part the donor recovers from well.
Timing matters: poor weight gain, worsening jaundice, bleeding or repeated infections are signs to see a transplant team early, not late.
After transplant, most children catch up in growth and return to school within a few months, on lifelong medicines and regular check-ups.

Why do children need a liver transplant?

Group	Examples	What it means
Blocked or absent bile ducts	Biliary atresia (after or without a Kasai operation), Alagille syndrome, progressive familial intrahepatic cholestasis (PFIC)	Bile cannot drain, the liver scars and cirrhosis develops, often in the first two years of life
Metabolic and genetic diseases	Wilson disease, maple syrup urine disease, urea cycle disorders, Crigler–Najjar syndrome, tyrosinaemia	The liver lacks one enzyme or protein; transplant replaces the missing function, sometimes before the liver is scarred
Acute liver failure	Viral hepatitis A or E, drug or toxin injury, Wilson disease presenting suddenly, unknown causes	A previously well child's liver stops working within days; some recover with intensive care, others need an urgent transplant
Liver tumours	Hepatoblastoma that cannot be removed by surgery after chemotherapy	Transplant is part of the cancer treatment plan with the paediatric oncology team

In biliary atresia, the Kasai operation (portoenterostomy) done in the first weeks of life can restore bile flow. When it is done early and works, a child may keep their own liver for many years. When it does not clear the jaundice, or cirrhosis develops later, a transplant becomes the treatment. Many conditions affecting children are also covered under autoimmune and genetic liver disease.

Signs a child should be seen by a transplant team

Jaundice that persists or returns after a Kasai operation, or pale stools with dark urine in a baby beyond two weeks of age.
Poor weight gain or muscle wasting despite good feeding — often an early sign the liver is failing.
A swollen abdomen from fluid (ascites) or a large spleen.
Repeated episodes of cholangitis (fever with worsening jaundice) after a Kasai operation.
Severe itching that disturbs sleep, or bleeding from the gut.

Take your child to hospital immediately if there is:

vomiting blood or passing black stools; unusual drowsiness, irritability or confusion; high fever with jaundice; bleeding that does not stop; or rapidly deepening jaundice in a previously well child. These can mean variceal bleeding, infection or acute liver failure, which need emergency care in a hospital with a paediatric intensive care unit.

A parent as the living donor

Because deceased donors are few and livers of the right size for small children are rarer still, most paediatric liver transplants in India use part of a parent's liver. For a baby or young child, the surgeon usually takes the left lateral segment (segments 2 and 3) — a small portion, commonly around a fifth of the adult's liver. The graft is sized to the child's weight; for very small infants it may be trimmed further.

Taking the left lateral segment is a smaller operation for the donor than the right-lobe donation used for adult recipients, and the donor's liver regrows over the following weeks. Most parent donors are in hospital for about a week and return to normal routines within a few weeks. The operation is explained on the liver donor surgery page, and eligibility and legal steps under THOTA in who can be a liver donor.

If neither parent is suitable, other near relatives such as grandparents or adult siblings can be assessed. Blood group need not always match in young children: babies make lower levels of blood-group antibodies, so ABO-incompatible transplant is often more straightforward in infants than in adults. Children are also eligible for deceased donor livers, including split livers — see deceased donor liver transplant.

The transplant operation and hospital stay

1
Evaluation
The child is assessed by the paediatric hepatology and transplant team: blood tests, scans to map blood vessels, heart assessment, infection screening, nutrition and dental review. Vaccines, especially live vaccines such as measles and chickenpox, are brought up to date before transplant where time allows.
2
Surgery day
The parent's operation and the child's operation run in parallel in two theatres. The child's diseased liver is removed and the graft's vein, portal vein, artery and bile duct are joined. The artery and veins in small children are only a few millimetres wide, so microsurgical technique is often used.
3
Intensive care
The child is monitored in the paediatric intensive care unit with frequent ultrasound checks of blood flow to the new liver.
4
Ward and discharge
Most children are in hospital for about two to four weeks. Families are taught how to give medicines, spot warning signs and attend frequent clinic visits in the first months.

The main early risks are clots in the hepatic artery or portal vein, bile leaks, bleeding, rejection and infection. Children, especially infants, are also prone to viral infections such as CMV and EBV because of the medicines that prevent rejection, so they are monitored with regular blood tests. Experienced centres commonly report one-year survival above 90% for children after living donor liver transplant, though each child's risk depends on their illness and condition before surgery.

Growth, school and family life after transplant

Most children feel and eat noticeably better within weeks. Growth often catches up over the first one to two years, particularly in children who were very malnourished beforehand. Children usually return to school or nursery a few months after transplant, once the medicine doses are stable and the team is happy with infection risk.

Medicines: anti-rejection medicines are given every day for life, at fixed times. Missed doses are a common cause of late rejection — particularly in teenagers, who need support as they take responsibility for their own care.
Vaccines: inactivated vaccines can usually continue on schedule after transplant; live vaccines are generally avoided, which is why they are given beforehand where possible.
Infection: children can play, attend school and mix with friends. Parents should report fever, diarrhoea or chickenpox contact promptly.
Follow-up: blood tests are frequent at first and become less frequent over months. Families outside Kolkata can often do blood tests locally and share results with the team.

Longer-term care is covered in life after liver transplant.

Seeing Dr Har about your child

Dr Bappaditya Har trained in paediatric liver transplantation at NCCHD in Tokyo, Japan, and performs paediatric living donor liver transplants in Kolkata at Narayana RN Tagore Hospital, Mukundapur, working with paediatric hepatologists, anaesthetists and intensivists. Parents in eastern India, the North-East and Bangladesh can send their child's reports on WhatsApp (+91 70420 39420) for an initial review before travelling, or call 080675 06860.

Frequently asked questions

At what age can a child have a liver transplant?

There is no lower age limit. Babies under one year, most often with biliary atresia, regularly receive transplants. The graft is sized to the child's weight.

Can a mother donate part of her liver to her baby?

Yes. Either parent can be assessed. The donor must be healthy, of suitable blood group (or ABO-incompatible transplant planned), and pass a full medical and psychological evaluation. A mother who has recently given birth is usually evaluated once she has recovered.

Is paediatric liver transplant successful?

Children generally do well. Experienced centres commonly report one-year survival above 90% after paediatric living donor liver transplant, and many children reach adulthood with their graft. Outcomes are poorer when a child is transplanted very late, severely malnourished or critically ill.

Does a Kasai operation mean my child will not need a transplant?

Not always. A successful Kasai operation can let a child keep their own liver for years, but many children with biliary atresia still need a transplant in childhood. Regular follow-up is essential.

Will my child grow normally after a liver transplant?

Most children show catch-up growth in the first one to two years. Growth depends on how unwell and malnourished the child was before transplant, steroid dose, and good nutrition afterwards.

How long does a parent donor take to recover?

After left lateral segment donation, most parents are in hospital about a week and can resume daily activities within a few weeks, usually in time to help care for their child.