Medical Specialties

The Pediatric Liver Transplant Process

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At Phoenix Children’s Hospital, your child and family will have the full support of the physicians, nurses, specialists and staff to guide you and support you through each step of the process.

The Liver Transplant Process:

  • Referral

A pediatrician, family practice doctor, gastroenterologist, or hepatologist from other hospital (2nd opinion) could refer your child to Dr. Tamir A. Miloh for an evaluation. If your insurance does not require a referral or prior authorization, you can call us to schedule an appointment at (602) 933-0940.

  • Consult Visit

Dr. Miloh or a member of his team will evaluate your child to determine what type of liver disease is affecting your child and provide the appropriate next steps.  Often, this includes a second consult visit with Dr. Winston Hewitt, our primary liver transplant surgeon, who may determine the next course of action, depending on the disease severity.

  • Tests

Testing may include blood work, CAT scans, MRIs, biopsies, ultrasound, echo-cardiogram or others.

  • Assessment and Diagnosis

You and your child will meet with the Liver Transplant team, including hepatologists, transplant coordinators, nurses, anesthesiologists, nutritionists, cardiologist, social workers, surgeons and other specialists to discuss the results of the assessment and evaluation.

Your child’s case is then reviewed by a multidisciplinary transplant selection committee to determine if your child should be placed on the transplant list or if any other tests are needed before making a decision.

About the listing process

If the transplant committee determines that a transplant is needed, your child is put on the United Network for Organ Sharing (UNOS) waitlist.

Childen listed on UNOS receive a score based on numerous clinical factors. The sicker your child is, the higher on the list they appear.   There are two types of scoring sytsems used for children, based on age.

  • PELD / MELD scores – UNOS determines the waiting list for children under 12 years old using the PELD (pediatric end-stage liver disease) score. UNOS determines your child’s score based on the short-term risk to their health if a liver transplant is not performed.

For children 12 years and older, UNOS uses the similar MELD (model for end-stage liver disease) score.

The PELD scoring system is based on a formula using five test results:

  1. Bilirubin levels – a measure of how well the liver excretes bile
  2. INR (prothrombin time) – a measure of how well the liver creates blood clotting factors
  3. Albumin – a measure of the liver’s ability to maintain nutrition
  4. Growth failure/nutrition status
  5. Age of child

The MELD scoring system is based on a formula using three test results:

  1. Bilirubin levels – a measure of how well the liver excretes bile
  2. INR (prothrombin time) – a measure of how well the liver creates blood clotting factors
  3. Creatinine – a measure of kidney function, which is often related to liver disease
  1. Exemptions to PELD/MELD Scores: A small percentage of children with special circumstances liver disease may be assigned priority status by UNOS:
  1. Status 1A – Children with sudden and severe onset liver disease
  2. Status 1B – Chronically ill children with certain metaboloic diseases, hepatoblastoma (liver tumor) or accute exacurbation of acute liver disease, under 18 years old
  3. Appeals - In case your child's PELD/MELD score does not reflect the severity of the liver disease, a plea can be made and must be approved by a UNOS appeal committee to receive more points.

Waitlist Times

Waitlist times are unpredictable and may range from days to a few years. Once an organ becomes available, a list is run by the OPTN. Organs are allocated by blood type, disease scrore, size, age and other donor specific criteria.

Being removed or temporarily deactivated from the list

Children on the waitlist may become more ill, to the point where a liver transplant may not improve their medical condition. Occasionally, children may recover from liver failure. In both cases, a child may be removed from the waiting list. A temporary deactivation from the list may ocurr if the child has a temporary, reversible condition such as an infection. Once the child recovers, they will be reactivated on the waitlist.  

Learn about what to expect while on the UNOS wait list.

Learn about the liver transplant surgery.

Contact us

(602) 933-0940

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