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Living-related liver transplantation for biliary atresia
S Fujita1, K Tanaka, Y Tokunaga
1Second Department of Surgery, Faculty of Medicine, Kyoto University, Japan.
Insights
Living-related liver transplantation (LRLT) offers a viable option for children with biliary atresia when other procedures fail. Postoperative complications were more frequent in children with an enteric stoma.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Medicine
Background:
- Biliary atresia is a severe condition in children requiring timely intervention.
- Previous surgical attempts like portoenterostomy may not achieve adequate biliary diversion.
- Liver transplantation is a critical option for end-stage liver disease in pediatric patients.
Purpose of the Study:
- To evaluate the initial outcomes of living-related liver transplantation (LRLT) in pediatric biliary atresia.
- To identify postoperative complications and influencing factors in LRLT for biliary atresia.
- To analyze the management strategies and long-term results of LRLT in this cohort.
Main Methods:
- Retrospective review of 29 pediatric patients undergoing LRLT for biliary atresia.
- Analysis of patient demographics, surgical history (including portoenterostomy), and graft details.
- Assessment of postoperative complications, management, and patient survival rates.
Main Results:
- Twenty-six out of 29 recipients (89.7%) are alive with a mean follow-up of 14 months.
- Postoperative complications occurred more frequently in children with an enteric stoma (4/5) compared to those without (4/24, p=0.007).
- Hospitalized children at transplantation showed a trend towards more frequent early postoperative complications (p=0.06).
Conclusions:
- LRLT provides a satisfactory outcome for children with biliary atresia unresponsive to repeated Kasai procedures or those with cirrhosis.
- The presence of an enteric stoma is associated with a higher incidence of postoperative complications.
- LRLT is a feasible and effective treatment for selected pediatric patients with biliary atresia.
Abstract:
We reviewed our initial experience of 29 living-related liver transplantations (LRLT) for children with biliary atresia in terms of postoperative complications and management to analyze the factors that may influence the outcome. All patients underwent an initial portoenterostomy at 17-134 days of age. The age distribution at the time of LRLT ranged from 6 months to 12 years, following revised portoenterostomy 0 to 3 times, and with (n=5) or without enteric stoma (n=24). Living-related donors provided the partial liver grafts weighing 170 to 630 g according to recipient size. Twenty-six of the 29 recipients are alive and well with follow-up between 1 and 27 (mean=14) months. Three patients died of extrahepatic complications including aspiration asphyxia, Candida infection and lymphoproliferative disorder. Four of 5 children with enteric stoma had 9 incidences of postoperative complication, while only 4 incidences occurred in 4 out of 24 children without stoma (p=0.007). Children hospitalized at the time of transplantation seemed to have early postoperative complications more frequently than home-bound children (p=0.06). The present results indicated that LRLT could offer satisfactory outcome for children in whom repeated Kasai's operation could not attain adequate biliary diversion and for those who developed cirrhosis despite good initial bile drainage.(ABSTRACT TRUNCATED AT 250 WORDS)