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Updated: Jun 28, 2026
Orthotopic Liver Transplantation in Rats
Published on: July 1, 2012
Timing for orthotopic liver transplantation in children with biliary atresia: a single-center experience
Y Toyoki1, K Hakamada, S Narumi
1Department of Surgery, Hirosaki University School of Medicine, Hirosaki, Aomori, Japan. ytoyoki@cc.hirosaki-u.ac.jp
Insights
Biliary atresia prognosis in children is predicted by total bilirubin levels 30 days after hepatoportoenterostomy (HPE). High bilirubin indicates a need for timely liver transplantation to improve outcomes.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Immunology
Background:
- Biliary atresia is a leading cause for pediatric liver transplantation.
- Early surgical intervention with hepatoportoenterostomy (HPE) is crucial.
Purpose of the Study:
- Identify prognostic factors for biliary atresia.
- Determine optimal timing for liver transplantation after HPE.
Main Methods:
- Retrospective analysis of 25 children with biliary atresia undergoing HPE.
- Evaluation of clinical data including bilirubin levels, liver function tests, and Pediatric End-Stage Liver Disease (PELD) scores.
Main Results:
- Five- and 10-year survival rates without liver transplantation were 47.4% and 26.3%.
- Multivariate analysis identified post-HPE total bilirubin level as the sole significant prognostic factor.
Conclusions:
- Total bilirubin level 30 days post-HPE predicts outcomes in biliary atresia.
- Children with elevated bilirubin post-HPE require timely orthotopic liver transplantation (OLT).
Introduction:
Biliary atresia is the most common indication for orthotopic liver transplantation (OLT) in childhood. The purpose of this study was to determine predictive prognostic factors for children with biliary atresia related to the timing for OLT within 15 months after hepatoportoenterostomy (HPE).
Patients And Methods:
We retrospectively analyzed the medical records of 25 children (7 boys and 18 girls) who underwent HPE because of biliary atresia between January 1990 and December 2005 at our center. Data examined included age and pathologic findings at HPE, Pediatric End-Stage Liver Disease score at first admission, whether phototherapy was given, liver function test results and total bilirubin level before and 30 days after HPE, and number of cholangitis events.
Results:
Twelve children were alive with their native liver, 8 had undergone living donor OLT (all children alive), and 5 had died without OLT. Five- and 10-year survival rates without OLT after HPE were 47.4% and 26.3%, respectively. At univariate analysis, the predictive prognostic factors for children with biliary atresia were total bilirubin level at 30 days after HPE and Pediatric End-Stage Liver Disease score before HPE. At multivariate analysis, the only prognostic factor was total bilirubin level at 30 days after HPE.
Conclusions:
In this study, the predictive prognostic factor was total bilirubin level at 30 days after HPE. Orthotopic liver transplantation within 15 months after HPE is needed in children with biliary atresia with a high total bilirubin level at 30 days after HPE.
