Related Experiment Video
Updated: Oct 12, 2025
A Mouse Model of Chronic Liver Fibrosis for the Study of Biliary Atresia
Published on: February 3, 2023
Organ-Specific Comorbidities Are Associated With Distinct Complications After Liver Transplantation for Biliary
Sarah A Taylor1, Veena Venkat, Ronen Arnon
1Department of Pediatrics Ann and Robert H. Lurie Children's Hospital of Chicago Chicago IL Department of Pediatrics University of Pittsburgh Medical Center Pittsburgh PA Department of Pediatrics Mount Sinai School of Medicine New York NY Department of Pediatrics Levine Children's Hospital at Atrium Health Charlotte NC Department of Pediatrics and Surgery University of California San Francisco San Francisco CA The Emmes Company LLC Rockville MD Department of Pediatrics Children's Mercy Hospital Kansas City MO.
Insights
Patients with biliary atresia (BA) and comorbidities face higher transplant risks, including graft loss and infection. However, comorbidities did not significantly increase patient death rates post-transplant.
Area of Science:
- Hepatology
- Pediatric Gastroenterology
- Transplantation Immunology
Background:
- Biliary atresia (BA) liver transplant outcomes have improved.
- Predicting post-transplant complications in BA patients with comorbidities remains challenging.
Purpose of the Study:
- To define the impact of comorbidities on post-transplant outcomes in biliary atresia (BA) patients.
- To identify risk factors for graft and patient loss in BA patients with comorbidities.
Main Methods:
- Analysis of 1034 BA patients from the Society of Pediatric Liver Transplantation registry (2011-2019).
- Patients grouped by comorbidities (>1.0% incidence): supplemental feeding, dialysis, other abdominal surgery, hepatopulmonary syndrome, cardiac disease.
- Statistical analysis included Kruskal-Wallis, chi-square, log-rank tests, Cox proportional hazards models, and logistic regression.
Main Results:
- 77% of BA patients had comorbidities, showing greater medical acuity (higher PELD scores, ICU admissions).
- Comorbid BA patients experienced more graft loss, longer hospitalizations, intubation, reoperations, and infections within 30 days post-transplant.
- Lower z-weight and higher creatinine were risk factors for graft/patient loss; prior Kasai portoenterostomy (KPE) was protective against infection and vascular complications.
Conclusions:
- BA patients with comorbidities have higher medical acuity and reduced graft survival but not significantly increased patient death.
- Findings aid in risk-stratifying BA patients for post-transplant outcomes.
- Organ-system-specific data can refine prognostic assessments for BA liver transplantation.
Abstract:
Although transplant outcomes for biliary atresia (BA) have improved, there are few data to predict the risk of specific posttransplant complications. We therefore defined the impact of comorbidities in BA on posttransplant outcomes. Patients enrolled in the Society of Pediatric Liver Transplantation registry from 2011 to 2019 (n = 1034) were grouped by comorbidities of >1.0% incidence: any supplemental feeding, dialysis, other abdominal surgery (not Kasai portoenterostomy [KPE]), hepatopulmonary syndrome, and cardiac disease requiring intervention. Demographic and outcome data were compared using the Kruskal-Wallis, chi-square, and log-rank tests. Cox proportional hazards models and binary logistic regression were performed for modeling. Patients with BA with comorbidities comprised 77% (n = 799) of our cohort and had evidence of greater medical acuity, including higher calculated Pediatric End-Stage Liver Disease scores and hospitalizations in the intensive care unit before transplant (P < 0.001 for both) versus those without comorbidities. After transplant, patients with BA with comorbidities had more graft loss (P = 0.02), longer initial hospitalization and intubation (P < 0.001 for both), and increased rates of reoperation (P = 0.001) and culture-proven infection (P < 0.001) within 30 days after transplant. Only patients with BA with comorbidities on supplemental feed had increased rates of patient death (P = 0.02). Multivariate analysis identified lower z weight and higher creatinine as risk factors for graft and patient loss in patients with BA with comorbidities. Prior KPE was protective against culture-proven infection and vascular complications within 30 and 90 days, respectively. Patients with BA with comorbidities have evidence of higher medical acuity at transplant and reduced graft survival; however, they overall did not experience greater incidence of patient death. Our data provide organ-system-specific data to risk-stratify patients with BA and posttransplant outcomes.
Related Concept Videos
01:17Chronic Bowel Disorders: Introduction
Irritable Bowel Syndrome (IBS) is a common disorder affecting the gastrointestinal tract. The distinctive feature is recurrent abdominal pain associated with altered bowel movements, manifesting as constipation, diarrhea, or fluctuating between both. The...
01:26Diseases of the Liver and Gallbladder
Cirrhosis is characterized by the scarring of hepatic lobules in the liver, which are replaced by fibrous tissue, affecting the liver's normal functioning. NAFLD, on the other hand, is caused by an excessive build-up of fat in the liver, not...
01:27Inflammatory Bowel Disease I: Ulcerative Colitis
Inflammatory bowel disease, or IBD, encompasses a group of disorders characterized by chronic inflammation or ulceration of the gastrointestinal tract.
Risk Factors
The exact cause of IBD remains unclear, although it is believed to be due to a mix of genetic, environmental, microbial, and immune factors. Genetic factors are significant in determining susceptibility to IBD, with family history being a critical risk factor. Individuals with a first-degree relative who has IBD are at...
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure