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Long-term outcomes of liver transplantation in biliary atresia: a 20-year single-center study
Zahra Beyzaei1, Alireza Shamsaeefar2, Kiana Ghatei1
1Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Insights
Pediatric liver transplantation for biliary atresia shows durable outcomes, with early post-transplant care being critical. Living donor and deceased donor liver transplants yielded similar results in this study.
Area of Science:
- Pediatric Surgery
- Transplantation Immunology
- Hepatology
Background:
- Biliary atresia (BA) is a leading indication for pediatric liver transplantation.
- Understanding long-term outcomes and survival factors is crucial for optimizing care in pediatric liver transplant recipients.
Purpose of the Study:
- To analyze long-term outcomes and survival rates of pediatric liver transplantation for biliary atresia.
- To compare outcomes between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT).
Main Methods:
- Retrospective, single-center analysis of pediatric patients (<18 years) undergoing liver transplantation for BA from March 2000 to June 2023.
- Data collected from electronic medical records, including clinical and laboratory parameters.
- Statistical analysis to determine graft and patient survival rates and identify influencing factors.
Main Results:
- A total of 160 patients were included, with a mean age of 4.5 years at transplantation.
- The cumulative 20-year graft survival rate was 63.8%, and 5-year patient survival was 64.4%.
- Early mortality (within 90 days) was primarily due to sepsis, pneumonia, and hemorrhage; chronic rejection contributed to late graft loss. LDLT and DDLT showed comparable outcomes.
Conclusions:
- Pediatric liver transplantation provides durable long-term outcomes, emphasizing the importance of early postoperative care.
- LDLT and DDLT demonstrated similar survival trends in this cohort.
- Further prospective, multicenter studies are needed to elucidate factors affecting long-term outcomes.
Background:
Pediatric liver transplantation is the definitive treatment for end-stage liver disease, including cirrhosis secondary to biliary atresia (BA). Understanding long-term outcomes and factors influencing survival is essential for optimizing care.
Methods:
We performed a retrospective, single-center analysis of pediatric patients (< 18 years) who underwent liver transplantation for biliary atresia between March 2000 and June 2023 at Abu-Ali Sina Hospital, Shiraz University of Medical Sciences. Clinical and laboratory data of patients were retrieved from electronic medical records.
Results:
A total of 160 patients were included, with a mean age at transplantation of 4.5 ± 0.8 years. The cumulative 20-year graft survival rate was 63.8%. Patient survival was 80% at 6 months and 64.4% at 5 years post-transplantation. Mortality was predominantly concentrated within the first 90 days following transplantation, with sepsis, pneumonia, and hemorrhage representing the leading causes of early death. Chronic rejection, although less frequent, remained a significant contributor to late graft loss. Notably, the decline in overall survival was largely driven by early post-transplant mortality, with survival curves demonstrating relative stabilization beyond the initial high-risk period. After adjustment for graft type and recipient sex, no statistically significant differences in graft or patient survival were observed. These findings are consistent with accumulating evidence that, in experienced centers, living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) yield comparable long-term outcomes.
Conclusions:
Pediatric liver transplantation offers durable long-term outcomes, with early postoperative care being critical. Both LDLT and DDLT showed similar trends in outcomes in this cohort, although no definitive differences could be established. Prospective, multicenter studies are warranted to further clarify factors influencing long-term outcomes.