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Living donor liver transplantation for biliary atresia - An Indian experience
Mohamed Safwan1, Priya Ramachandran1,2, Mettu Srinivas Reddy1
1Institute of Liver Disease and Transplantation, Global Health City, Perumbakkam, Chennai, Tamil Nadu, India.
Insights
Living donor liver transplantation (LDLT) offers excellent outcomes for children with biliary atresia (BA). Both primary LDLT and LDLT after Kasai portoenterostomy (KPE) yield comparable results, with primary LDLT being more challenging due to younger patient age.
Area of Science:
- Pediatric Surgery
- Hepatology
- Transplantation Immunology
Background:
- Biliary atresia (BA) is a leading indication for pediatric liver transplantation (LT).
- Living donor liver transplantation (LDLT) has emerged as a viable option for improving outcomes in children with BA.
- Evaluating institutional experience with LDLT for BA is crucial for refining surgical strategies.
Purpose of the Study:
- To review a five-year experience of LDLT in children diagnosed with BA.
- To assess the outcomes and complications associated with LDLT in this pediatric population.
- To compare outcomes between primary LDLT and LDLT following Kasai portoenterostomy (KPE).
Main Methods:
- Retrospective review of 132 pediatric LDLT cases from August 2010 to June 2015.
- Selection of 58 patients with a primary diagnosis of BA.
- Data extraction from a prospectively maintained database, case notes, and imaging studies; statistical analysis performed.
Main Results:
- 58 children with BA underwent LDLT; 33 had prior KPE, 25 had primary LT.
- Post-operative complications occurred in 34 children (13 minor, 21 major).
- 30-day and 1-year survival rates were 96.6% and 91.4%, respectively. Age, weight, PELD, and GRWR differed significantly between primary LT and post-KPE groups.
Conclusions:
- LDLT demonstrates excellent outcomes for children with BA.
- Primary LDLT and LDLT after KPE achieve equivalent results.
- Primary LDLT is technically more demanding due to the younger age of recipients.
Abstract:
LT has played a significant role in improving the outcome of children with BA. We review our five-yr experience of LDLT for children with BA. Records of all children who underwent LDLT in our institution over a five-yr period (August 2010-June 2015) were reviewed and those with a primary diagnosis of BA were selected for our study. Data were extracted from a prospectively maintained database. Additional data were collected by review of case notes and imaging studies. Analysis was carried out using standard statistical means. One hundred and thirty-two children underwent LDLT at our center over the study period, of which 58 children (31 females) had a primary diagnosis of BA. Thirty-three (56.9%) children had undergone a prior KPE and 25 (43.1%) had a primary LT. Thirty-four children had at least one post-op complication, of which 13 had minor complications (Clavien grades I and II) and 21 had major complications (Clavien grade >II). Thirty-day survival was 96.6% and one-yr survival was 91.4%. Univariate analysis of variables comparing children who did and did not have a KPE prior to LT showed that age at LT, weight at LT, PELD, and GRWR were significantly different. LDLT provides excellent outcomes in children with BA. Primary LDLT and LT after KPE provide equivalent results, although the former is technically more challenging as the child is younger.
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