Can primary LDLT be the alternative first line treatment for infant patients with biliary atresia?

Abstract

Background/aims: The outcome of the Kasai operation remains unsatisfying. This study aims to evaluate the feasibility and effectiveness of primary LDLT on biliary atresia (BA) treatment for infant patients.

Methodology: Fifty infant patients with BA who were treated in our center between Jan 2008-Jan 2011 were included. Seventeen of them received LDLT. Another 33 patients received Kasai operation as the first line treatment. All patients had no history of previous abdominal surgery. Records of these patients and the donors for LDLT were retrospectively reviewed.

Results: The follow-up ranged from 12-48.5 months; 30 postoperative-day survival of the LDLT patients and Kasai patients were 82.4% and 81.8%, respectively (p=1). One-year survival of the two groups was 82.4% and 60.6% (p=0.200). Jaundice free rate of the patients who survived at least one month after the surgery was 100% vs. 70.4% of the LDLT group and Kasai group, respectively (p=0.035). Main cause of death in LDLT group was hepatic artery thrombosis and multiple organ dysfunction syndrome in the Kasai group.

Conclusions: Primary LDLT is a safe and efficient management for infant patients with BA. It may serve as an alternative first line treatment for BA treatment with specific indications.