170 - Pediatric Living Donor Liver Transplantation - Little Patients, Big Impact!
Description: Presently, according the United Network for Organ Sharing there are over 400 children waiting for a liver transplant in the United States. At the Cleveland Clinic we are performing living donor liver transplants and frequently the transplant recipient is a child. Most of our pediatric patients are afflicted with biliary atresia, a condition in which a child’s bile is blocked, creating a buildup of bile in the liver. A kasai procedure is the first line of treatment but sometimes this is not effective. This leads to liver failure and the need for transplantation. The nursing care of the pediatric liver transplant donor and recipient requires specialized equipment, techniques, and consideration. The donor can be a family member but is often times unrelated and anonymous. The donor will have 15% to 30% of their liver removed, and it will regenerate within one year. A multidisciplinary team approach is essential to successful patient outcomes. Numerous multidisciplinary planning meetings involving surgeons, anesthesia, nursing, scheduling, and transplant coordinators occur prior to each procedure. These teams ensure the two patients are compatible and everything is optimized. Current assessment of transplant process identified a knowledge deficit around these difficult and specialized cases. We established a dedicated team of nurses to be specially trained and become experts. They work closely with the surgeons and have optimized care by knowing each step and process of the surgery. The transplant is performed using over 200 instruments, two staff surgeons, three fellows or residents, two anesthesia providers, and two nurses. The donor side is often the same amount of providers. We perform both procedures in parallel operating rooms at the same time with coordinating teams. The donor surgery takes around five to six hours to perform, and the recipient surgery takes around eight to 12 hours. The surgical team will complete a minimum of three vascular anastomoses and one or two bile duct anastomoses, often requiring microscopic work. The team approach allows for quicker setup, more engaged nurses, trusting relationships amongst surgeons and anesthesia providers, and an overall improvement in patient care. In a liver transplant every second counts in order to ensure a safe operation, less time under anesthesia, and better patient outcomes. The nursing team not only needs to be trained in both scrubbing and circulating liver transplants but also needs to be trained in the care of the pediatric patient. The pediatric living donor liver transplant is truly a unique and valuable surgery that provides a lifesaving procedure with no wait list time. To be a part of the liver transplant team is truly fulfilling, challenging, and rewarding. Overall the creation of the team has had a positive impact on patient care, the surgical process, and nursing satisfaction.