Successful Treatment of Biliary Atresia in Very Small Infants through Living Related Liver Transplantation

Abstract

Improving outcomes in very small children is a major goal of pediatric liver transplantation. This report describes our experience of living related liver transplantation in an infant weighing 3.98 kg. The recipient, a 80-day-old male infant with congenital biliary atresia, was treated with living donor liver transplantation and then followed up for 6 months. The left lateral segment (segment II, III) with reduced size from the donor, his 26-year-old mother, was used as the graft. The graft weighed 200 g. The graft weight to recipient body weight ratio was 5.025%. The donor regained her liver function within 3 days and was discharged on day 8. The patient showed good results. Liver function returned to normal 9 days after the operation with bilirubin level almost decreased to normal. Cyclosporin, mycophenolate mofetil and prednisone were used for postoperative immunosuppression. No bleeding, thrombosis, infection or bile leakage occurred. The patient had slight fever because of a little collection in the abdomen and recovered after paracentesis and drainage. He was discharged on day 16. The donor and recipient are in satisfactory condition at present. Improvement of technique in hepatic surgery, microsurgical technique in vascular surgery and postoperative intensive care are the keys to ensure the success of the procedure.

Fig. 1

The liver parenchyma was excised well to the right of the attachment of the falciform ligament.

Fig. 2

Donor hepatic angiogram showing normal arterial structure.

Fig. 3

Cholangiography of the donor. Two branches of right bile duct (anterior and posterior right bile ducts) of the mother.