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Long-Term Outcome of Adult-to-Adult Living Donor Liver Transplantation for Post-Kasai Biliary Atresia

  1. Y. Uchida1,3,*,
  2. M. Kasahara2,
  3. H. Egawa2,
  4. Y. Takada1,
  5. K. Ogawa1,
  6. Y. Ogura1,
  7. K. Uryuhara1,
  8. D. Morioka1,
  9. S. Sakamoto1,
  10. Y. Inomata4,
  11. Y. Kamiyama3,
  12. K. Tanaka1,2

Article first published online: 1 AUG 2006

DOI: 10.1111/j.1600-6143.2006.01487.x

Issue

American Journal of Transplantation

American Journal of Transplantation

Volume 6, Issue 10, pages 2443–2448, October 2006

Additional Information

How to Cite

Uchida, Y., Kasahara, M., Egawa, H., Takada, Y., Ogawa, K., Ogura, Y., Uryuhara, K., Morioka, D., Sakamoto, S., Inomata, Y., Kamiyama, Y. and Tanaka, K. (2006), Long-Term Outcome of Adult-to-Adult Living Donor Liver Transplantation for Post-Kasai Biliary Atresia. American Journal of Transplantation, 6: 2443–2448. doi: 10.1111/j.1600-6143.2006.01487.x

Author Information

  1. 1

    Department of Transplantation and Immunology, Kyoto University Faculty of Medicine, Kyoto, Japan

  2. 2

    Organ Transplant Unit, Department of Transplant Surgery, Kyoto University Hospital, Kyoto, Japan

  3. 3

    Department of Surgery, Kansai Medical University Hospital, Osaka, Japan

  4. 4

    Department of Pediatric and Transplant Surgery, Kumamoto University Hospital, Kumamoto, Japan

* *Corresponding author: Yoichiro Uchida, uchiday@kuhp.kyoto-u.ac.jp

Publication History

  1. Issue published online: 1 AUG 2006
  2. Article first published online: 1 AUG 2006
  3. Received 8 February 2006, revised 7 June 2006 and accepted for publication 9 June 2006

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Keywords:

  • Adult;
  • biliary atresia;
  • liver transplantation;
  • living donor

Among patients receiving living donor liver transplants for biliary atresia, post-transplant complications were signficantly higher and survival was lower in adults compared to children.

Our objective was to analyze problems in the perioperative management and long-term outcome of living donor liver transplantation (LDLT) for biliary atresia (BA). Many reports have described the effectiveness of liver transplantation (LT) for BA, particularly in pediatric cases, but little information is available regarding LT in adults (≥16 years old). Between June 1990 and December 2004, 464 patients with BA underwent LDLT at Kyoto University Hospital, of whom 47 (10.1%) were older than 16 years. In this study, we compared the outcomes between adult (≥16 years old) and pediatric (<16 years old) patients. The incidence of post-transplant intestinal perforation, intra-abdominal bleeding necessitating repeat laparotomy and biliary leakage was significantly higher (p < 0.0001, <0.001 and <0.001, respectively) in adults. Overall cumulative 1-, 5- and 10-year survival rates in pediatric patients were significantly higher (p < 0.005) than in adults. Two independent prognostic determinants of survival were identified: a MELD score over 20 and post-transplant complications requiring repeat laparotomy. Outcome of LDLT in adult BA patients was poorer than in pediatric patients. It seems likely that LT will be the radical treatment of choice for BA and that LDLT should be considered proactively at the earliest possible stage.

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