Liver transplantation for biliary atresia: A single-center study from mainland China

Abstract

Aim: To summarize our single-center experience with liver transplantation (LT) for biliary atresia (BA).

Methods: From October 2006 to December 2012, 188 children with BA were analyzed retrospectively. The stage I group (from October 2006 to December 2010) comprised the first 74 patients, and the stage II group (from January 2011 to December 2012) comprised the remaining 114 patients. Finally, 123 liver transplants were performed in 122 (64.9%) patients, whereas 66 patients did not undergo LT due to denial by their parents or lack of suitable liver grafts. The selection of graft types depended on the patients' clinical status and whether a suitable living donor was available. The characteristics of patients in stages I and II were described, and the surgical outcomes of LT recipients were compared between the two stages. The Kaplan-Meier method was used to estimate the cumulative patient and graft survival rates, and the equality of survival distributions was evaluated using the log-rank test.

Results: The 188 children consisted of 102 boys and 86 girls. Their ages ranged from 3 to 144 mo with a median of 8 mo. One hundred and fifteen (61.2%) patients were born in rural areas. Comparing stage I and stage II patients, the proportion of patients referred by pediatricians (43.2% vs 71.1%, respectively; P < 0.001) and the proportion of patients who previously received a Kasai procedure (KP) (32.4% vs 44.7%, respectively; P = 0.092) obviously increased, and significantly more parents were willing to treat their children with LT (73% vs 86%, respectively; P = 0.027). Grafts from living donors (102/122, 83.6%) were the most commonly used graft type. Surgical complications (16/25, 64.0%) were the main reason for posttransplant mortality. Among the living donor liver transplantation recipients (n = 102), the incidence of surgical complications was significantly reduced (34.1% vs 15.5%, respectively; P = 0.029) and survival rates of patients and grafts were greatly improved (81.8% vs 89.7%, respectively, at 1 year; 75.0% vs 87.8%, respectively, at 3 years; P = 0.107) from stage I to stage II.

Conclusion: The status of surgical treatments for BA has been changing in mainland China. Favorable midterm outcomes after LT were achieved as centers gained greater technical experience.

Keywords: Biliary atresia; Kasai; Liver transplantation; Living donor; Pediatric; Survival.

Figure 1

Geographical distribution of children with biliary atresia (n = 188).

Figure 2

Caseload of children with biliary atresia from 2006 to 2012 (n = 188).

Figure 3

Flowchart providing outcomes of children with biliary atresia. BA: Biliary atresia; KP: Kasai procedure; LDLT: Living donor liver transplantation; LT: Liver transplantation; SLT: Split liver transplantation; WLT: Whole liver transplantation.

Figure 4

Patient and graft survival after liver transplantation for biliary atresia (n = 122). A: Comparison between patients using different donor types (P = 0.286); B: Comparison between patients with or without a prior Kasai procedure (KP) (P = 0.701); C: Comparison between patients in stages I and II (P = 0.358); D: Comparison between the two stages within the living donor liver transplantation (LDLT) group (P = 0.107). NA: Not available.