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. 2024 Mar 1:11:1242009.
doi: 10.3389/fped.2023.1242009. eCollection 2023.

Long-term outcomes of liver transplantation for biliary atresia and results of policy changes: over 20 years of follow-up experience

Yiyoung Kwon #  1 , Yoon Ji Ahn #  2 , Jaehun Yang  3 , Eun Sil Kim  4 , Yon Ho Choe  2 , Sanghoon Lee  5 , Mi Jin Kim  2
Affiliations

Long-term outcomes of liver transplantation for biliary atresia and results of policy changes: over 20 years of follow-up experience

Yiyoung Kwon et al. Front Pediatr. .

Abstract

Objective: Biliary atresia (BA) patients develop chronic liver disease after the Kasai operation and are eventually indicated for liver transplantation (LT). The purposes of this study were to analyze long-term outcomes after LT and risk factors that affect complications to reduce graft failure.

Study design: Overall, 145 pediatric patients who underwent LT between June 1996 and June 2020 after a diagnosis of BA were included. We performed a retrospective analysis of medical records and evaluated patient and graft survival, cumulative incidence of complications, risk factors, and the results of policy changes.

Results: Patient and graft survival rates in over 20 years were 95.8% and 91.0%, respectively. Post-transplantation lymphoproliferative disease was frequently observed in the early period of immunosuppression within the first 1-2 years after LT. The incidence of cholangitis and rejection steadily increased over time. Weight-to-portal vein size was evaluated as a risk factor for cholangitis and bile duct strictures (OR = 12.82, p = 0.006 and OR = 16.54, p = 0.015, respectively). When evaluated using 2013 as a reference point, the split graft indication was expanded and the group that received LT after 2013 had a significantly lower survival over time compared with that of the group that received LT before 2013 (p = 0.006).

Conclusion: This study revealed time differences in prevalence of complications. The evaluation of weight-to-duct or vessel size is a more important factor in considering complications than the graft-to-recipient weight ratio. Survival outcomes may have been altered by a policy change that affects the donor type ratio in transplantation.

Keywords: biliary atresia; complication; graft failure; liver transplantation; risk factor.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Cumulative patient and graft survival function using Kaplan-Meier survival analysis of liver transplantation in 145 pediatric patients with biliary atresia.
Figure 2
Figure 2
Cumulative complications (A) cholangitis, (B) rejection, (C) PTLD, and (D) bile duct stricture, portal vein stenosis, hepatic artery stenosis, or vein problems using Kaplan-Meier survival curve after liver transplantation in 145 pediatric patients with biliary atresia. PTLD, Post-transplantation lymphoproliferative disease.
Figure 4
Figure 4
(A) Cumulative patient survival function using Kaplan-Meier survival analysis of two groups with liver transplantation classified by the year 2013 in 145 pediatric patients with biliary atresia. (B) Cumulative patient survival function using Kaplan-Meier survival analysis of three groups with liver transplantation classified according to donor differences in 145 pediatric patients with biliary atresia.
Figure 3
Figure 3
(A) Annual number of liver transplantations at a single tertiary referral center in South Korea. (B) Counts of liver transplantations according to donor type before and after 2013.
See this image and copyright information in PMC

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