Relevant factors for early liver transplantation after Kasai portoenterostomy

Liang Ge,Shengqiao Zhao,Xiaodan Xu,Jianghua Zhan,Ran Dou,Wei Gao

doi:10.1186/s12887-020-02355-8

Liang Ge, Shengqiao Zhao + Show 4 more

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https://doi.org/10.1186/s12887-020-02355-8

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Abstract

BackgroundTo explore the relevant factors for early liver transplantation (LT) after Kasai portoenterostomy (KP).MethodsRetrospective analysis was performed for 200 children with biliary atresia, who underwent LT with hepatic failure after KP. According to the interval between KP and LT, they were divided into three groups: G1 (≤6-month), G2 (6-month~ 2-year) and G3 (> 2-year). Gender, age of Kasai portoenterostomy, jaundice-clearance, cholangitis after KP and liver function indexes before LT were compared among the three groups.ResultsThe proportion of patients with age of KP (≤90-day) in G1 was lower than that in G3 (P = 0.003). Jaundice-clearance occurred in 6 (7.6%), 26(28.6%) and 26 (86.7%) patients after KP in G1, G2 and G3 respectively (P < 0.001). There were statistical differences in the incidence of early cholangitis, late cholangitis and repeated cholangitis among the three groups (P = 0.035, < 0.001 and 0.022). The native liver survival (NLS) rate of children at operation age > 90-day was lower than that of children at operation age ≤ 90-day (P = 0.002). The NLS rate of the children with jaundice-clearance after KP was significantly better than that of the children without jaundice-clearance (P < 0.001). The NLS rate of the children with early cholangitis after operation was lower than that in children without early cholangitis (P = 0.026). The NLS rate of patients of G2 and G3 with cholangitis after KP was lower than that in children without cholangitis (P = 0.017). Multiple logistic regression analysis showed uncleared jaundice after KP was a risk factor for the NLS time in patients.ConclusionThe age of KP (> 90-day), jaundice-unclear and early cholangitis could reduce the NLS time after KP, which were related to early liver transplantation. Jaundice-unclear was a risk factor for early liver transplantation.

Highlights

To explore the relevant factors for early liver transplantation (LT) after Kasai portoenterostomy (KP)
Which factors lead to LT in a short time after KP? How to regulate these factors to improve the native liver survival time after KP? Is it necessary to avoid the attack of KP and directly perform LT for some patients who would have no effect after KP? The objective of this study is to identify the relevant factors for early LT after KP
A total of 8 variables from the clinical and laboratory database were obtained for study, including gender, age of KP, jaundice-clearance was defined as to achieve normal bilirubin level within 6 months post-Kasai [7], cholangitis [8], early cholangitis was defined as to occur within 1 month after KP, late cholangitis was defined as to occur 1 month after KP, repeated cholangitis defined as the occurrence of cholangitis more than three times in 6 months after KP and biochemical indicators of liver function (i.e. ALB, Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), Direct bilirubin (DBIL), Alkaline phosphatase (ALP) and GGT) before liver transplantation were analyzed

Summary

Introduction

To explore the relevant factors for early liver transplantation (LT) after Kasai portoenterostomy (KP). Biliary atresia (BA), characterized by progressive inflammation and fibrous obstruction of hepatic bile ducts, is a serious hepatobiliary disease in infancy. Kasai portoenterostomy has been a primary operation for biliary atresia since professor Morio Kasai first performed in 1959. Shinkai et al [1] reported that the 5-, 10-, and 20-year survival rates of patients with their native livers were 63, 54, and 44%, respectively. Nio [2] reported that 20-year native-liver survival rate was 49%. The native liver survival after KP in mainland China is not optimistic. Less than 30% of the patients could achieve long-term survival with native liver after KP, and most of them eventually die or receive LT [3]. Liver transplantation is constrained by the shortage of donor, high cost and lifelong use of anti-rejection drugs after operation, living donor liver transplantation for treating

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