Near the Children's Hospital we have fee-based housing ranging from 2 to 3 rooms (the kitchen is counted in Geneva as a room) for children (who are sick or who have a transplanted liver) and their families near the Children's Hospital. You can walk there. We can give you a map to show you where the housing is located.

The rates are as follows: CHF 30.00 for a one-night stay, CHF 25.00 per night for a two to five-night stay and CHF 15.00 per night for a longer stay.

We ask that you book your accommodations by phone or email as soon as you know that your child will be hospitalized in Geneva.

Contact information for the association that manages the housing:

Association for assistance to a child undergoing transplantation and the family [Association pour l’aide à l’enfant greffé et à sa famille (APAEG)
Georgette Genton
Tel.: +41 22 793 69 38
Email: apaeg@bluewin.ch
Please make your booking via email to Ms. Genton of the APAEG: g.genton@bluewin.ch

In case of unavailability, Ronald McDonald Houses offer studios starting at CHF 20.00 per night and rooms starting at CHF 15.00 per night. These accommodations are close to the Children’s Hospital and you can walk there.

Ronald McDonald House
Avenue de la Roseraie 53
1205 Geneva
Tel.: +41 22,382 86 01
Fax: +41 22,382 86 03
E-mail: rmh.geneve@ch.mcd.com
Website: www.ronaldmcdonald-house.ch

Feel free to consult our little information guide regarding meals, housing and transportation:

 

No, but you can leave it in a fee-based underground parking lot (the Cluse parking lot is the closest, 200 meters from the Children's Hospital).

 

You can also park in the Migros parking lot at Rue Dancet 21 or leave your car in a P+R parking lot (less expensive than the Cluse/Lombard parking lot), with the closest being the Bout-du-Monde parking lot (Route de Vessy 12).

Meals are not offered to parents in the Division. However, you can eat in the cafeteria of the Children's Hospital which is open from Monday to Friday from 7:30 a.m. to 7 p.m.

In addition, there are many restaurants near the Hospital and supermarkets (Coop, Migros, etc.) 300-500 meters from the Hospital.

A microwave oven is also available in the kitchen on the floor to heat dishes.

Feel free to consult our little information guide below:
    

Yes, a cot is made available to you. However, only one parent is allowed to stay overnight at the hospital.

This intervention consists of reconstituting the bile duct outside of the liver by putting an intestinal loop at the entrance of the liver (where the bile flows).The goal is to allow bile to flow into the intestine and to relieve the liver. It is indicated in case of bile duct atresia.

This should be done early in the child's life to maximize the chances of success.It can restore the biliary flow from the liver to the intestine, preventing the liver from getting worse, which will then avoid liver transplant. 

As a general rule, donations from parents or other family members are avoided. However, depending on the severity of your child's illness and the degree of urgency, this option may be considered on an exceptional basis.

Your child's body may perceive the graft as a foreign body and try to attack it. This does not necessarily mean that the transplant has failed.

Anti-rejection drugs, such as Prograf®, Cellcept®, or Neoral® decrease the activity of your child's immune system and help prevent rejection.

The earlier the rejection is detected, the easier it is to treat.

It is an infection of the bile ducts due to intestinal germs. Following an intervention using the Kasaï procedure, bacteria in the intestinal loop can cause cholangitis.

In this situation, your child will receive intravenous antibiotic treatment and will be closely monitored. This means that the child’s hospital stay will be prolonged.

The operation itself will take between 6 and 10 hours. However, your child will usually stay in the operating room between 10 and 14 hours.

You will receive regular updates from the transplant team.

Following an infection, liver cell dysfunction or a bile duct problem, your child may have jaundice from birth or later.

It is due to an accumulation of bilirubin in the blood, a substance found in bile.

Duct atresia is a rare disease of unknown origin. It is characterized by obstruction of the bile ducts, and appears during the first weeks of life.

Your child is partially or totally lacking in bile ducts. The bile that normally flows through these ducts from the liver to the intestine stagnates in the liver.

This causes liver dysfunction, which then causes your child's jaundice. It is the most common cause of neonatal cholestasis (biliary retention).

It is a rare disease and affects 1 live birth in 18,000 in Europe. Girls are affected a little more often than boys.

Bile duct atresia is characterized by discoloration of the stool associated with an increase in the size of the liver.

A stool color chart can be used to help with its diagnosis, which you can view/download here.

Your child is at a higher risk of developing complications related to an infection, especially a viral one.

For example, if transplanted children catch a respiratory illness, such as a cold, they are more likely to develop pneumonia or otitis the next time this happens.

This risk is higher immediately after the transplant and decreases over time.
 

Your child may die from severe liver disease or complications before a transplantation can be performed, but deaths are rare.

Yes, especially during the first three months. The risk persists for the rest of the person’s life.

Almost all young transplant patients experience at least one episode of rejection.

Depending on the diagnosis, your child may recover without surgery or a liver transplant.

If, on the other hand, your child’s liver function has irreversibly deteriorated and the risk of death exceeds the risk of living with the damaged liver, your child will be put on the transplant waiting list.

When the condition becomes irreversible and life-threatening, recourse to a liver transplant is necessary.

In fact, in the absence of treatments to cure your child, his liver function will increasingly deteriorate (jaundice, risk of bleeding, ascites, etc.) to the point that the risk of death will exceed the risk of living with the damaged liver.

Because of the possibility of severe complications.

CMV can have effects on several organs and cause rejection.

In very rare cases, EBV can result in lymphoproliferative syndrome (PTLD), which is a precursor to lymphoma (early stage).

And the chickenpox virus can cause many complications in a child who did not develop immunity before transplantation.

A characteristic of these three viruses is that they remain inactive in cells and reappear later, which makes it difficult to treat them. Please feel free to contact the Center if you have any questions.

There are multiple possible complications during and after a liver transplant. They include surgical and medical complications.

Surgical complications

Despite all precautions, the following complications are the most common and occur in 5 to 10% of children with transplants. The same figures are found at the other reference centers throughout the world.

  • Any surgery can cause bleeding. A child who receives a new liver very often needs a blood transfusion.
  • Other complications are directly related to liver transplant surgery:
    • Thromboses (clots) in vessels that have been sutured. Thrombosis of the portal vein or hepatic artery often requires a new operation. 
    • Leakage of bile, which is often treated by the insertion of a drain. 
    • Narrowing of the bile duct most often requires interventional radiologists to insert a bile duct drain. 

There are also other surgical complications, but these occur less frequently.

Medical complications

Medical complications can be classified into three categories:

  • Infections (most often viral)
  • Rejection
  • Side effects of medications required after the transplant can affect other organs    

Votre enfant est surveillé de très près de manière à réagir rapidement en soignant les complications et en adaptant son traitement.

Enfin, très rarement, le décès peut malheureusement survenir suite à ces complications. C’est pourquoi une greffe de foie est proposée après une longue réflexion entre les parents et notre équipe.

Ensemble, les risques et les bénéfices de la greffe ont été soigneusement évalués.  Une greffe est proposée dans l’une des deux situations : 

  • si le risque vital de l’enfant avec son propre foie est plus élevé que les risques liés à la transplantation
  • si la qualité de vie ou le développement de l’enfant est fortement compromis.  
     

It varies depending on your child's illness and its severity.

It could take anywhere from a few days to several months, even one or two years.

If your child is registered for invalidity insurance (AI), all outpatient and hospital expenses are covered for the pathology concerned. 

If your child does not benefit from the AI, the outpatient treatment is reimbursed as part of the basic health insurance benefits (KVG/LAMal), after deduction of the deductible and contribution (10% of the dependent expenses) up to a maximum of CHF 350 per year.

Children (or young adults in training aged 19 to 25) do not pay the daily contribution to the cost of hospital accommodation (food, accommodation).

Feel free to contact the team and the department's social worker if you have any questions.

 

Drugs & vaccines

Apart from paracetamol, please refer to the table below.

Interactions

Yes, your child’s vaccination schedule will be resumed as early as one year after the transplant based on the Center's recommendation and follow-up.

For more information on vaccines: INFOVAC

Yes. Even if your child has a nasogastric tube. As with tacrolimus, other immunosuppressive medication, including Nifedipine®, Amphomoronal® and Mycostatin®, should preferably be taken by mouth.

The other treatments can be administered through the tube. However, because the tube is temporary, it is best for your child to get used to taking its medication by mouth.

Do not change the tacrolimus administration schedule. Continue to give it to your child at the same time as usual based on the new time zone.

For example:

8 a.m. during standard time in the winter => 8 a.m. during daylight savings time in the summer

8 a.m. in Geneva => 8 a.m. in New York

At first, six drugs a day are prescribed, as a preventive measure, to reduce the side effects of the immunosuppressant. They protect against high blood pressure, renal failure and the risk of viral or bacterial infection. Then, this number gradually decreases over the years (1 to 3/day).

Types of medication
Prednisolone® or Prednisone®
Bactrim®
Aspirin®
Valcyte®
Ursofalk®
Antihypertensive treatments:  Norvasc® (Amlodipine), Reniten® (Enalapril) 
Aquadek®, Magnesium, Calcimagon D3®

 

Use the half-hour rule:

  • if your child has a vomiting episode within the first half hour after administering the medication, you can give your child the same dose again.
  • if the vomiting episode occurs a half hour or more after administering the medication, do not give it again because it has probably already been absorbed.

Please feel free to call our Center if you have any questions or if vomiting persists.

There are no contraindications for using homeopathy. In the absence of validated studies, care should be taken with products such as spagyric tinctures.

Regarding herbal medicine, vigilance is required regarding plant origin, concentrations and the quality of the preparations.

We invite you to discuss this with a team member who can get advice from the clinical pharmacology Division.

To the best of our current knowledge, yes. A transplant recipient must take immunosuppressive treatment throughout his life. Studies are currently underway.

All grapefruit products are prohibited. In fact, grapefruit juice can significantly increase tacrolimus levels in the blood and significantly increase its adverse effects on the kidneys.

If your child eats grapefruit or drinks juice containing grapefruit by accident, you must immediately contact the transplant team [1]to determine whether tacrolimus levels in your child’s blood should be checked.

Your child should always take tacrolimus or another immunosuppressant:

  • by mouth 
  • at the same time
  • under the same conditions, whether on an empty stomach or with a meal

These essential precautions help to reduce fluctuations in the level of medicationin the blood. The analysis of the results is therefore more reliable, which makes it easier to adjust the treatment.

However, if blood levels vary too much despite these precautions, doctors suggest that you give your child tacrolimus on an empty stomach within a certain time period before it eats any food.

The information in the table below is used as a general rule, but treatment may vary depending on the situation:

Types of medication General duration for taking post-transplant medication
Prednisolone® or Prednisone® 3 months following a declining pattern
Bactrim®  One year
Aspirin® 3 months or according to the surgical indication
Valcyte® 6 months
Ursofalk® 6 to 12 months or depending on the medical indication

Antihypertensive treatments:  Norvasc® (Amlodipine), Reniten® (Enalapril) 

depending on your child’s recovery
Aquadek®, Magnesium, Calcimagon D3® depending on your child’s recovery

 

At the hospital

Yes, they are actually encouraged. However, if any family members show signs of infection (a cold, cough, diarrhea, etc.), they must abstain from visiting your child for the duration of the symptoms.

For your child’s comfort, the number of visitors is limited to two people at a time.

Yes, you can stay with your child, whether in intensive Care or Pediatric Surgery.

Yes, that is a good idea. Remember to bring the dishes that they like. However, do not give them tap water. Our teams will provide you with bottled water.

Once opened, the bottle must be consumed within 24 hours. The food and the meal tray should be consumed quickly (do not keep “opened” food in the room).

Your child will stay in Intensive Care for a few days (4 to 5 days), and then be admitted to the Pediatric Surgery floor for about 3 weeks.

The duration of hospitalization may vary, depending on the child’s state of health.
 

Yes, after you have informed the nursing team. But the child must wear a mask. Masks are available for you in the unit. You can also go for a walk with them around the hospital.

  • Always wash your hands with soap and water before your first daily contact with your child.
  • Throughout the day, disinfect your hands before entering and leaving the room with a water-based alcohol solution. 
  • In case you come in contact with biological fluids, such as urine, blood or stool, wash your hands with soap and water.

How should we wash our hands?

Comment bien se laver les mains ?

At home

Up to 3 months after a liver transplant

  • Raw meat and cold meats, raw fish and smoked salmon, and raw eggs are forbidden.
  • Marbled cheeses (like Roquefort) or that have a mold/washed rind (like Camembert / Vacherin Mont d’Or) are prohibited. 
  • All pasteurized cheeses are allowed (Gruyère, Vacherin Fribourgeois, Emmental, Babybel, etc.), even cheese that says "raw milk" on the package.
  • Milk must be pasteurized or UHT. No raw milk from the farm.
  • All other drinks and tap water are allowed.

After and throughout the rest of the person’s life

  • Grapefruit (fruit, juice, juice mixture) is not allowed because it is incompatible with taking Tacrolimus or Cyclosporine

No. However, if one of your child’s siblings is sick, physical contact with the child who has undergone the transplant should be avoided as much as possible.

During the first six months after the transplant, it is best to avoid closed public places with a high density of people, such as shopping malls, movie theaters or concert halls, especially in winter.

If you need to go shopping or travel by public transport, try to go out during the times when things are less crowded.

  • No sports for the first six weeks but it is recommended  to move as soon as possible and to walk.
  • For the first three months, no intensive or contact sports, and no scooter riding or jumping on a trampoline.
  • After that, no restrictions. Competitive sports up to the Olympic level are possible.

It is not recommended to have birds, snakes, turtles or lizards as pets because of the risk of contamination with fungi. If you already have these animals as pets, your child who has undergone a transplant must avoid any contact with them and absolutely must not help with their care, such as cleaning cages, a vivarium or other terrarium, nor feed them.

Cats, dogs, horses, cows and other animals pose no problems. However, avoid getting any new animals as pets during the first year after transplantation. 

Yes, as long as the child's seat is thoroughly dried after you have used the wipe to avoid leaving it wet. Moisture actually promotes the proliferation of fungi (fungal infections).

Generally 3 to 6 months after the transplant.

No, just wash them carefully by hand or in the dishwasher.

Using basic hygiene measures is the best way to avoid contamination.

You should use them on a daily basis, regardless of your location and situation (hospital, home, school, travel, etc.):

  • Wash your hands regularly with soap and water, for example, after using the toilet, before cooking or eating, on returning home, after recreational activities or taking a break, on leaving the hospital or the doctor’s office, etc.
  • Use a water-based alcohol solution when there is no water available.
  • If you have a cold, sneezing or coughing, use a tissue and dispose of it in the trash after use, and then wash or disinfect your hands.

 

Usually 2 to 3 months after the transplant.

The storage, preparation and cooking of food must be done in a "clean environment": 

  • Clean your refrigerator regularly (once or twice a month)
  • Wash your utensils and dishes carefully:

- either by hand with hot water and liquid dish detergent (and then dry them with a clean towel)

- or in the dishwasher with the temperature set to 60°

  • Keep your work spaces clean.
  • Wash your hands before cooking.
  • Prepare small amounts at meals to avoid leftovers and cook all foods thoroughly.
  • Store fresh or already cooked foods in the refrigerator.
  • Eat leftovers, use up the baby food in jars and opened packages within 48 hours of storing them in the refrigerator.
  • Cook frozen foods directly without defrosting them first.
  • Never refreeze food that has already been thawed.
  • Check product expiration dates.
  • When shopping, wrap up fresh foods and then put them in an insulated bag to avoid breaking the cold chain.

No, this is not necessary unless your child's blood pressure was high in the hospital. In this case, your doctors will ask you to measure it at home.

In the ocean: yes, but you must apply “total SPF coverage” sunscreen because the effect of tacrolimus (immunosuppressive medication) makes the skin more sensitive to the harmful effects of the sun (skin cancer).

In a pool: It is recommended that public pools be avoided during the first post-transplant year. On the other hand, private swimming pools (at your home, or at the homes of friends or family) are allowed.

In case of fever

Your child is considered to have a fever if its temperature is higher than

  • 38°C during the first year after the transplant
  • 38.5°C after this

First, remove your child's clothes and give it a bath with the water half a degree below its temperature. You can give them paracetamol (Dafalgan®, for example).

If the fever persists despite these measures, call your pediatrician or take your child [1]directly to the closest Children’s Hospital.

IMPORTANT : THE MORE RECENT THE TRANSPLANT, THE GREATER THE NEED FOR YOUR CHILD TO BE SEEN BY A DOCTOR QUICKLY.

In case of fever or pain, it is recommended to give/use only paracetamol, Dafalgan®, Panadol®, BenUron®, etc.

CAUTION: Do not give Ibuprofen®, Algifor®, Irfen®, Brufen®, Nurofen®, etc., from the NSAID family (= non-steroidal anti-inflammatory drugs) because of the risk of renal failure.

If these medications are prescribed to you, refuse them. Please feel free to contact the Center in case of doubt.

Yes, every 6 hours in case of pain or fever.