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Living Donor Liver Transplantation for Young Biliary Atresia Recipients Is Associated With Improved Outcomes in the
Ioannis A Ziogas1,2, Dor Yoeli1,2, Megan A Adams1,2
1Colorado Center for Transplantation Care, Research and Education (CCTCARE), department of Surgery, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
Insights
Living donor liver transplantation (LDLT) improves survival for children under two with biliary atresia (BA). However, socioeconomic disparities exist, necessitating equitable access to LDLT programs for better outcomes.
Area of Science:
- Pediatric Hepatology
- Transplant Surgery
- Clinical Outcomes Research
Background:
- Biliary atresia (BA) is the leading cause of pediatric liver transplantation (LT).
- Identifying survival risk factors in young BA patients is crucial in the current era of LT.
- Understanding factors influencing graft and patient survival post-LT for BA is essential.
Purpose of the Study:
- To identify risk factors associated with patient and graft survival in children under two years old undergoing their first liver transplant for biliary atresia.
- To analyze the impact of different graft types (deceased donor whole grafts, deceased donor technical variants, living donor LT) on outcomes.
- To investigate the role of demographic and clinical factors, including insurance status and ICU admission, on survival.
Main Methods:
- Retrospective analysis of 1226 pediatric patients (<2 years) with biliary atresia who received their first isolated LT.
- Data sourced from the United Network for Organ Sharing database between January 2013 and December 2022.
- Multivariable Cox regression analysis incorporating graft type, race/ethnicity, insurance, PELD score, portal vein thrombosis history, and ICU status.
Main Results:
- Living donor LT (LDLT) recipients were more likely to be white and have private insurance.
- Intensive care unit (ICU) status significantly increased the risk of both patient mortality (HR=3.23) and graft loss (HR=1.89).
- Deceased donor grafts (whole and technical variants) were associated with a higher risk of graft loss compared to LDLT.
Conclusions:
- LDLT is linked to improved survival rates in pediatric patients under two with biliary atresia.
- Significant socioeconomic disparities exist between LDLT and non-LDLT recipients.
- Promoting equitable referral to LDLT centers is vital for enhancing outcomes in young children with BA.
Introduction:
Biliary atresia (BA) is the most common indication for liver transplantation (LT) in children. We aimed to identify risk factors associated with survival in young patients with BA in the modern era.
Methods:
We performed a retrospective analysis of BA patients aged < 2 years who received their first isolated LT with available data from the United Network for Organ Sharing database (01/2013-12/2022). Factors included in the multivariable Cox regression were graft type, race/ethnicity, insurance status, laboratory pediatric end-stage liver disease (PELD) score, history of portal vein thrombosis, and intensive care unit (ICU) status.
Results:
1226 BA LT recipients aged < 2 years were included, of whom 501 (40.9%) received deceased donor whole grafts (DDWG), 425 (34.7%) received deceased donor technical variants (DDTV), and 300 (24.5%) received living donor LT (LDLT). LDLT recipients were more likely to be white (p = 0.008) and have private insurance (p < 0.001). Multivariable analysis demonstrated that ICU status (hazard ratio [HR] = 3.23, 95% confidence interval [95% CI]: 1.72-6.08, p < 0.001) and DDTV graft vs. LDLT (HR = 3.03, 95% CI: 1.14-8.04, p = 0.03) were associated with an increased risk of patient mortality. Factors associated with an increased risk of graft loss included ICU status (HR = 1.89, 95% CI: 1.19-3.00, p = 0.007) and both DDWG (HR = 3.37, 95% CI: 1.65-6.87, p = 0.001) and DDTV (HR = 3.47, 95% CI: 1.69-7.14, p = 0.001) grafts vs. LDLT.
Conclusion:
LDLT is associated with improved survival in patients with BA aged < 2 years; however, socioeconomic differences exist between LDLT and non-LDLT recipients. Efforts to promote early equitable referral to centers offering LDLT are essential for improving outcomes in young children with BA.
