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Pediatric Liver Transplant and Hepatobilliary Program

Pediatric Liver Transplantation

Appointments, Referrals, Information: 914.493.8916

A New Era of Pediatric Liver Transplant under the Leadership of Seigo Nishida, MD, PhD

The Pediatric Liver Transplant Program at Maria Fareri Children’s Hospital, a member of the Westchester Medical Center Health Network (WMCHealth), offers a full range of pediatric liver disease and transplant services – and ensures support and dignity for every patient and family.

The Pediatric Liver Transplant Program is affiliated with the prestigious Adult Liver Transplant Program at Westchester Medical Center. This affiliation allows the collaboration of clinical care with an advanced adult liver transplant team. The program cares for children of all ages with end-stage liver disease and acute liver failure, both before and after transplantation.

The Pediatric Liver Transplant team is led by Dr. Seigo Nishida, Chief of Liver and Pediatric Transplantation, and Dr. Richard Rosencrantz, Medical Director for Pediatric Liver Transplant. Our multidisciplinary team, in the state-of-the-art Maria Fareri Children’s Hospital, includes experts in pediatric hepatology, pediatric gastroenterology, transplant surgery, pediatric surgery, pediatric cardiology, pediatric cardiothoracic surgery, pediatric anesthesiology, interventional radiology, infectious disease, nursing, nutrition, pharmacy, social work, child life services, psychiatry and rehabilitation, as well as pediatric intensivists, who care for seriously ill infants and children or those who need a high level of monitoring in a specialized inpatient unit.

Providing compassionate and excellent medical care to our patients and their families is our highest goal. Our Pediatric Liver Transplant Program supports you every step of the way and customizes a treatment plan to achieve the best outcome possible. Our doctors and team members provide plain-talk explanations, encouragement and doorways to proven, valuable resources. They will help you and your family gain knowledge to make important decisions so you can do so with dignity and on your terms. We consider this personal touch essential: We care for you the way we would care for our own families.

Highly Skilled, Experienced Team

 
Seigo Nishida, MD, PhD
Chief, Liver and Pediatric
Transplantation

 

Richard Rosencrantz, MD
Medical Director, Pediatric
Liver Transplant
The Pediatric Liver Transplant Program is led by Seigo Nishida, MD, PhD, Chief of Liver and Pediatric Transplantation. Prior to joining Maria Fareri Children’s Hospital in November 2017, Dr. Nishida was Interim Director of Adult and Pediatric Liver Transplant for the Miami Transplant Institute at Jackson Memorial Hospital, Miami Florida – one of the leading pediatric liver transplant programs in the country. During Dr. Nishida’s time there, more than 660 pediatric liver transplants were performed, with one year and three year post-transplant survival rates above the national average. Dr. Nishida has over 21 years of experience and is an internationally recognized leader in liver transplant. He also is a prolific researcher, with over 150 peer-reviewed publications and 250 presentations. Under Dr. Nishida’s leadership, the Westchester Medical Center liver transplant team more than doubled adult liver transplant volume in 2018, the most in a single year since 2009.

Richard Rosencrantz, MD, Pediatric Hepatologist, has been the Medical Director for the Pediatric Liver Transplant Program since 2011. Dr. Rosencrantz is board certified in both pediatric gastroenterology and pediatric transplant hepatology and has over 18 years of experience in pediatric hepatology and liver transplant. His area of expertise includes acute liver failure, end stage liver disease / cirrhosis of any etiology, biliary atresia, Alagille syndrome, autoimmune hepatitis, Wilson disease, drug induced liver injury and metabolic diseases. Maria Fareri Children’s Hospital has a large Pediatric Gastroenterology Department with 15 board certified physicians, with satellite offices conveniently located in Westchester, Brooklyn, Manhattan, The Bronx, Rockland, Orange and Dutchess counties, and western Connecticut.

In addition to Dr. Nishida, there are four intra-abdominal transplant surgeons. Dr. Gregory Veillette is credentialed for pediatric kidney and liver transplant surgery. Additionally, as Chief of Hepatobiliary and Pancreatic Surgery, Dr. Veillette has expertise in pediatric hepatobiliary surgery, which is any (non-transplant) surgery involving the liver, gallbladder, or bile ducts. Dr. Devon John, Chief of Renal Transplantation, is credentialed to perform pediatric kidney transplants but may also assist in pediatric liver transplants. Dr. Thomas Diflo, Chief of Intra-Abdominal Organ Transplantation, and Dr. Hiroshi Sogawa, Surgical Director for Adult Kidney Transplant, are primarily adult transplant surgeons but will also assist in pediatric liver transplants.

Maria Fareri Children’s Hospital has the region’s only level IV (most sophisticated) neonatal intensive care unit; highest level, all-specialty, 18-bed medical and surgical pediatric intensive care unit, and level I pediatric trauma center. Maria Fareri Children’s Hospital recognizes that expert medical care is only one component of healing and recovery. Extensive resources are available for patients and their families through Child Life and Creative Arts Therapy services that utilize multiple playrooms, an art studio, as well as art and music therapy programs. The Ronald McDonald House, located on the Maria Fareri Children’s Hospital campus, offers housing and resources to families and caregivers of patients admitted to the hospital. Maria Fareri Children’s Hospital also offers private in-patient rooms, including ICU beds, with bathrooms, showers and parent sleeping areas. Additionally, there are pre-school, elementary and teen-aged activity rooms and a unique lobby providing visual diversions for children and families, including a walk-through aquarium, a performing arts stage, a New York baseball museum, and the world's largest doll-house.

As pediatric transplant patients mature into adulthood, continuity of care continues as they are transitioned to our trusted adult liver transplant team for pre- and post-transplant management. Dr. Nishida is also the Surgical Director for the Adult Liver Transplant Program. The Medical Director for Adult Liver Transplant, David C. Wolf, MD, has been a member of the liver transplant program since its inception in 1996. Dr. Wolf is a well-respected transplant hepatologist, especially known for his expertise and compassion.

Thank you for trusting the Pediatric Liver Transplant Program team and allowing us to be part of your care – and future.


Appointments, Referrals, Information
Pediatric Liver Transplant Program
914.493-8916
914.493-1097 fax

Maria Fareri Children’s Hospital
100 Woods Road
Valhalla, NY 10595

Intra-Abdominal Transplant Clinic
Westchester Medical Center
Ambulatory Care Pavilion
100 Woods Road
Valhalla, NY 10595

Patient Transfers or Emergencies
Contact the Westchester Medical Center Transfer Center at 914.493.5555. Assistance is available around the clock, seven days a week.

Care for a Wide-Range of Liver Conditions

The Pediatric Liver Transplant Program offers highly specialized care for infants, children, adolescents and young adults with a wide range of liver diseases, including:

  • Acute liver failure
  • Alagille syndrome
  • Alpha-1-antitrypsin deficiency
  • Autoimmune hepatitis
  • Biliary atresia
  • Budd-Chiari syndrome
  • Familial and genetic cholestatic diseases
  • Cirrhosis
  • Cystic fibrosis
  • Drug induced liver injury
  • Hepatitis (autoimmune, non-alcoholic fatty liver disease, non-typeable, viral B and C)
  • Liver tumors (hepatoblastoma and hepatocellular carcinoma)
  • Metabolic liver diseases
  • Portal vein thrombosis
  • Pediatric solid-tumor care
  • Primary biliary cirrhosis
  • Primary sclerosing cholangitis
  • Wilson Disease

Liver conditions are treated through the following procedures, which are performed in the Children’s Surgery Center of Maria Fareri Children’s Hospital:

  • Kasai procedure
  • Liver transplantation
  • Segmental liver resection
  • Partial external biliary diversion
  • Ileal exclusion
  • Shunt surgery (Meso-Rex bypass, distal splenorenal)
  • Pancreatectomy
  • Whipple procedure
  • Cholecystectomy
  • Laparoscopic liver and biliary surgery
  • Laparoscopic pancreatic surgery
  • Laparoscopic gallbaldder surgery
  • Surgical procedures for acute and chronic pancreatitis

 


Appointments, Referrals, Information
Pediatric Liver Transplant Program
914.493-8916
914.493-1097 fax

Maria Fareri Children’s Hospital
100 Woods Road
Valhalla, NY 10595

Intra-Abdominal Transplant Clinic
Westchester Medical Center
Ambulatory Care Pavilion
100 Woods Road
Valhalla, NY 10595

Patient Transfers or Emergencies
Contact the Westchester Medical Center Transfer Center at 914.493.5555. Assistance is available around the clock, seven days a week.

The transplant process includes four phases that start well before potential surgery. Please click on each link to learn more. 

Evaluation and Suitability for Transplant

Pre-Transplant Waiting Period

Transplant Surgery

Post-Transplant Care

Evaluation and Suitability for Transplant

Once a referral for potential liver transplant has been made to the Pediatric Liver Transplant Program, an extensive evaluation is completed before your child can be placed on the transplant waiting list. Not all patients require a transplant, which is why the evaluation is essential. Importantly, the evaluation process is an opportunity for you and your child to meet the transplant team and learn more about liver transplantation. Our pediatric liver transplant nurse coordinator guides patients and families through this process with patience, compassion and educational information.

The transplant evaluation includes a thorough medical and surgical evaluation, blood tests, extensive diagnostic testing and studies and psychosocial evaluation of the child (if age-appropriate) and the family. Diagnostic testing typically includes a chest X-ray, echocardiogram, electrocardiogram, CT scan, MRI, ultrasound and liver biopsy. Other testing may also be necessary, and consultations may be required to draw upon the expertise of Maria Fareri Children’s Hospital specialists in pediatric cardiology, infectious diseases, genetics/metabolic medicine, pulmonology, neurology, psychiatry, and other medical specialties.

Transplant team members who will meet with you and your child include a transplant hepatologist, transplant surgeon, anesthesiologist, transplant social worker, pharmacist, nutritionist and financial coordinator. Discussions will include the results of the evaluation determining if liver transplant is appropriate, aspects of the surgery, donor options and post-transplant care.

Liver Living Donation

The gift of life, organ donation, is the most generous gift one can give another. A liver transplanted from a live donor -- a healthy adult who can safely donate a portion of his or her liver, and whose blood type is compatible with the recipient -- may be an option for your child. Following transplant, the donor’s remaining liver, as well as the partial liver transplanted to the recipient, will grow, forming complete livers within a few months.

If living donor liver transplant is an option for your child and a living donor has been identified, the donor-evaluation process begins. Similar to the transplant-candidate evaluation, the donor evaluation includes blood tests, diagnostic testing and consultations to determine if donation can be done safely and if the donor is suitable for the recipient. Once a donor is approved, the living donor surgery and liver transplant are scheduled in coordination with you and your family, the donor and liver transplant team. For more information about living donation, please click HERE.

If living donor liver transplant is not an option, you will be asked to sign a consent form to place your child on the United Network for Organ Sharing (UNOS) national list to wait for a liver from a medically compatible deceased donor.

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Pre-Transplant Waiting Period

The UNOS national registry equitably identifies deceased donors’ livers for possible transplantation and promotes effective, safe care and efficient organ use. Decisions on who receives a donation is based solely on the severity of the potential recipient’s condition and the urgency of undergoing a transplant. The level of illness for pediatric liver candidates is based on the Pediatric End-Stage Liver Disease (PELD) score. Availability of donor livers, medical compatibility (based on size and blood type) and changes in the transplant candidate’s condition are prime determinants of when a transplant may be possible.

When a donor liver becomes available, UNOS first screens outs candidates who are not a match. This determination is based on blood type, size and possibly other criteria. Candidates who are compatible based on blood type and size are ranked based on the extent of their condition and the urgency of receiving a transplant. The transplant center treating the first candidate on the list will determine if the organ offer is suitable for the candidate. If not, the second potential recipient will be considered, and so forth. A different list is generated each time a donor becomes available; therefore, no candidate has a specific number on the list.

When your child is considered for a donor organ, the transplant team determines if the offer is suitable. A transplant team member will discuss the organ offer with you. Ultimately, you have the choice to accept or decline any organ for your child. The availability of a donor liver may occur at any time, day or night, so it is extremely important that you are available by phone and can come to Maria Fareri Children’s Hospital at a moment’s notice.

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Transplant Surgery

On the day of surgery, your child will be admitted to Maria Fareri Children’s Hospital; a bed will be reserved for your child. You will meet with Dr. Nishida and his team, including the transplant coordinator, pediatric anesthesiologist and other specialists. They will explain the procedure and answer questions. You will be asked to sign consent forms and other documents, and blood will be drawn from your child for pre-transplant testing. While the donor liver is en route to Maria Fareri Children’s Hospital, your child will be taken to the operating room.

The comfort and well-being of you and your child, as well as helpful communication, are priorities throughout the procedure. The procedure typically lasts four to eight hours, but the duration of surgery can be affected by many factors, including delays in the donor surgery and transit time. The transplant coordinator will update you on the progress of your child’s transplant surgery, especially if surgery is longer than anticipated, and will address your questions. After surgery, your child will be transferred to the Pediatric Intensive Care Unit (PICU) to be monitored very closely. Once stable, your child will be transferred within Maria Fareri Children’s Hospital, which is divided into age-specific "neighborhoods" with their own themes, decor and snack centers.

During the entire hospital stay, you child will be attentively cared for by the entire multidisciplinary transplant team. As preparations are made for discharge, you and your family will be educated on all aspects of post-transplant care, including information about medications, activity, follow-up and nutrition.

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Post-Transplant Care

In the first few months following transplant, your child’s progress will be closely evaluated through weekly transplant clinic and laboratory appointments. The team will meticulously check for signs of rejection or infection, and ensure your child’s surgical incisions are healing. Laboratory results will assess liver function, kidney function and blood count, and monitor the level of immunosuppression medications in your child’s blood. Your child will take immunosuppression medications for the rest of his or her life to prevent rejection. The doctor will review your child’s medications at each visit and may adjust doses. If your child experiences side effects, medications may be adjusted or changed. Occasionally, the doctor may order additional tests, such as a colonoscopy, ultrasound and biopsy.

The following symptoms, which may be signs that your child is experiencing rejection, infection or a complication, should be immediately reported to the Transplant Team:

  • Fever
  • Jaundice (yellowing of the skin or whites of the eyes)
  • Dark urine
  • Itching
  • Abdominal swelling or tenderness
  • Fatigue
  • Irritability
  • Headache
  • Nausea

Prior to discharge from Maria Fareri Children’s Hospital, the nutritionist will assess your child’s food intake and may offer recommendations to follow after returning home. After liver transplant, your child’s appetite should gradually return to normal. It is possible your child will be prescribed steroids, such as prednisone, following transplant. This medication calls for a no-salt-added diet; too much salt may worsen fluid retention, a common condition when steroids are used. Other dietary restrictions post-transplant are unlikely, but a nutritionist is available to answer questions and offer recommendations.

Depending on your child’s recovery, follow-up medical visits will occur monthly, then less frequently, and, eventually, annually. Compliance with medication use and follow-up care is critical to long-term success after pediatric liver transplantation. It is very important that you assist your child with the following, especially if your child is too young to take responsibility for his or her health:

  • Taking medicines as directed.
  • Completing testing and check-ups.
  • Attendance at medical appointments.
  • Rescheduling missed appointments.

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Appointments, Referrals, Information
Pediatric Liver Transplant Program
914.493-8916
914.493-1097 fax

Maria Fareri Children’s Hospital
100 Woods Road
Valhalla, NY 10595

Intra-Abdominal Transplant Clinic
Westchester Medical Center
Ambulatory Care Pavilion
100 Woods Road
Valhalla, NY 10595

Patient Transfers or Emergencies
Contact the Westchester Medical Center Transfer Center at 914.493.5555. Assistance is available around the clock, seven days a week.

At Maria Fareri Children’s Hospital, families play an active role in the healing process, which is why we believe in providing each family member with the resources they need on the journey toward recovery.

Child Life and Creative Arts Therapy

Our Child Life and Creative Arts Therapy team works closely with pediatric transplant patients and families as they adjust to the physical and emotional rigors of pre- and post-transplant care. Using music, literature, art and therapeutic play, Child Life team members provide support for children, siblings and parents by encouraging them to be creative and tap into their strengths. For more information, click HERE.  

Family Resource Center

The Family Resource Center is a welcoming and relaxing setting with comfortable sofas and chairs, computers with internet access, and a multitude of children’s books available to all Maria Fareri Children’s Hospital patients and families. Mary Delaney, LCSW, Director of Family Support and the Family Resource Center, is available to assist with a family's needs during a child's hospitalization. A multi-talented group of volunteers pride themselves on helping families in any way needed. Volunteers assist with a variety of services, including bringing books to the patient's bedside as part of the traveling library program, and staffing the laundry room.

Families are encouraged to use the Family Resource Center to:

  • Participate in a coffee hour or support group for family members of hospitalized children.
  • Talk with someone who can offer understanding and suggestions for coping when a child in the hospital.
  • Choose from a full range of children's books for your child to read.
  • Access the internet and email.
  • Conduct online research.
  • Conduct personal business.
  • Charge cellphones.
  • Take a break and relax, without being far from your child's bedside.

The Family Resource Center is conveniently located on the first floor of Maria Fareri Children's Hospital in Room 1118. For more information, click HERE.  

Support Groups

In addition to support groups conducted at the Maria Fareri Children’s Hospital Family Resource Center, our transplant social worker facilitates a monthly Transplant Caregiver Support Group for caregivers of pre- and post-transplant patients. We also facilitate a Transplant Life Support Group for both pre- and post-transplant patients and their families. A variety of helpful, “hands-on” topics are discussed at these meetings.

We also conduct transplant education and support group meetings at MidHudson Regional Hospital, a member of the Westchester Medical Center Health Network (WMCHealth) in Poughkeepsie, NY, and Good Samaritan Hospital, also a member of WMCHealth in Suffern, NY. The Pediatric Liver Transplant Program also collaborates with the Transplant Support Organizations (TSO) in Westchester and Rockland counties. They hold monthly support and educational meetings.

Ronald McDonald House

The Ronald McDonald House of the Greater Hudson Valley, located just steps away from Maria Fareri Children’s Hospital in Valhalla, provides a temporary home away from home for families of children facing illness. Available 24 hours a day, 365 days a year, Ronald McDonald House is a two-story building with 13,500 square feet of living space, private bedrooms and baths, a fully functional kitchen, laundry facilities, a play room and lounge area. Ronald McDonald House can accommodate up to 12 families per night. A Rejuvenation Room is available for families not staying overnight; showers and rest areas are available in three-hour blocks between 9 a.m. and 5 p.m. For more information, click HERE.  

Harboring Hearts Program

The Harboring Hearts Program, through the continued generosity of the LiveOnNY Foundation, assists heart and liver transplant families by providing temporary housing, transportation and food conveniently near Maria Fareri Children’s Hospital during and after transplant. The Harboring Hearts Program is committed to keeping families together through the transplant processes. For more information, please speak to your transplant coordinator and/or social worker. The LiveOnNY Foundation is the charitable arm of LiveOnNY, the federally designated organ-procurement organization responsible for securing organs and tissue for transplantation in Westchester, Putnam, Dutchess, Rockland and Orange counties, New York City and Long Island.

 


Appointments, Referrals, Information
Pediatric Liver Transplant Program
914.493-8916
914.493-1097 fax

Maria Fareri Children’s Hospital
100 Woods Road
Valhalla, NY 10595

Intra-Abdominal Transplant Clinic
Westchester Medical Center
Ambulatory Care Pavilion
100 Woods Road
Valhalla, NY 10595

Patient Transfers or Emergencies
Contact the Westchester Medical Center Transfer Center at 914.493.5555. Assistance is available around the clock, seven days a week.

Appointments, Referrals, Information
Pediatric Liver Transplant Program
914.493-8916
914.493-1097 fax

Maria Fareri Children’s Hospital
100 Woods Road
Valhalla, NY 10595

Intra-Abdominal Transplant Clinic
Westchester Medical Center
Ambulatory Care Pavilion
100 Woods Road
Valhalla, NY 10595

Patient Transfers or Emergencies
Contact the Westchester Medical Center Transfer Center at 914.493.5555. Assistance is available around the clock, seven days a week.

Dhand, Abhay
Dhand, Abhay
Director, Transplant Infectious Diseases
Associate Professor of Medicine
Infectious Disease
Diflo, Thomas
Diflo, Thomas
Chief, Intra-Abdominal Transplant Surgery
Professor of Surgery
General Surgery
Hepatobiliary Surgery
Transplant Surgery
John, Devon
John, Devon

Chief, Renal Transplantation
Knoll, Bettina
Infectious Disease
Nishida, Seigo
Nishida, Seigo
Chief, Liver and Pediatric Transplant
General Surgery
Hepatobiliary Surgery
Transplant Surgery
Nog, Rajat
Nog, Rajat
Transplant Infectious Disease Physician
Infectious Disease
Rosencrantz, Richard
Rosencrantz, Richard
Medical Director, Pediatric Liver Transplantation
Clinical Associate Professor of Pediatrics
Hepatobiliary Disease
Pediatric Gastroenterology
Transplant Hepotology
Sogawa, Hiroshi
Sogawa, Hiroshi
Surgical Director, Kidney Transplantation
Associate Professor of Surgery
General Surgery
Hepatobiliary Surgery
Transplant Surgery
Veillette, Gregory
Veillette, Gregory
Chief, Hepatobiliary and Pancreatic Surgery
Surgical Director, Pancreas and Pediatric Kidney Transplantation
Assistant Professor of Surgery
General Surgery
Hepatobiliary Surgery
Pancreatic Surgery
Transplant Surgery
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