Effects of Kusai operation on living donor liver transplantation for children with biliary atresia

Abstract

Objective To evaluate the effects of Kasai operation on living donor liver transplantation (LDLT) for children with biliary atresia.Methods Retrospective reviews were conducted for 53 children undergoing LDLT from March 2010 to March 2013.Among them,28(52.8％) underwent LDLT after Kasai operation while 19(35.8％) had LDLT without prior Kasai operation.The intergroup differences of general profiles,postoperative complications and cumulative survival rate were compared.Results Significant differences existed in age and weight at transplantation,pretransplant bilirubin level,pediatric end-stage liver disease (PELD) score and operative duration (all P＜0.05) while there were no significant inter-group differences in graft/recipient weight ratio (GRWR),graft weight,warm ischemia time,cold ischemia time,blood loss,blood transfusion and hospital stay (all P＞0.05).No significant inter-group differences existed in the incidence of such complications as pulmonary infection,abdominal cavity infection,wound infection,sepsis,acute rejection,portal venous anastomotic stenosis,cytomegalovirus/Epstein-Barr virus infection or biliary complications (all P＞0.05).Among 4 deceased recipients,3 died from graft failure in Kasai group and another in non-Kasai group.No donor mortality was encountered.The overall 1-month,1 and 3-year cumulative survival rates for recipients were 98.1％,92.5 ％ and 92.5 ％ and the 1-month,1 and 3-year cumulative survival rates for Kasai group were 92.9％,89.3％ and 89.3％ respectively.And the 1-month,1 and 3-year cumulative survival rates for non-Kasai group were 96％,96％ and 96％ respectively.No significant inter-group differences existed (P =0.4069).Conclusions As the first sequential treatment for biliaryatresia,Kasai operation does not increase the incidence of complications and mortality after transplantation.And its success may postpone transplantation.The later in life transplantation must be performed,the lower the incidence of complications and mortality is noted. Key words: Biliary atresia; Kasai operation; Liver transplantation