Long-Term Outcome of Living Donor Liver Transplantation After Kasai Operation for Biliary Atresia: A More Than 15 Years Follow-Up in a Single Center.

Abstract

Background. Since our department firstly introduced Kasai operation from 1960's, Kasai operation has been preferred as initial treatment for biliary atresia (BA), although long-term survival was not sufficient. After the introduction of liver transplantation, the long-term outcome of BA dramatically improved. We started living donor liver transplantation (LDLT) from 1991, allowing us to examine issues related to long-term survival. The aim of this study was to review the long-term outcome of LDLT after Kasai operation. Patients and Methods. We performed 160 LDLT from 1991 to 2013, including 22 biliary atresia patients who survived more than 15 years after LDLT. They were investigated for complication, immunosuppressive therapy and social status. Results. The average age at LDLT was 3.0 years old (from 5 months to 16 y.o.). The present average age is 20.5 y.o. (from 15 - 30 y.o.). The average age at Kasai operation was 67 days, and the average interval from Kasai operation to LDLT was 41 months. Five of the 22 recipients were frequently readmitted due to biliary stenosis even more than 5 years after LDLT. The present immunosuppressive therapy is tacrolimus or cyclosporine alone, and one recipient become immunosuppression free. Chronic rejection and secondary liver failure were not seen. All these patients, except for 1, attend a normal school or have an occupation. Conclusion. General status of the recipients was stable more than 15 years after LDLT. Biliary stenosis was the most important factor in terms of the long-term outcome.