Research Article| April 01 2019 Transplant May Be Best Initial Treatment in Biliary Atresia AAP Grand Rounds (2019) 41 (4): 44. https://doi.org/10.1542/gr.41-4-44 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Transplant May Be Best Initial Treatment in Biliary Atresia. AAP Grand Rounds April 2019; 41 (4): 44. https://doi.org/10.1542/gr.41-4-44 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: biliary atresia, liver transplantation, transplantation Source: LeeVan E, Matsuoka L, Cao S, et al. Biliary-enteric drainage vs primary liver transplant as initial treatment for children with biliary atresia. JAMA Surg. 2018 12 September [published online ahead of print]; doi: https://doi.org/10.1001/jamasurg.2018.3180Google Scholar Investigators at multiple institutions conducted a retrospective cohort study to compare overall survival among children with biliary atresia (BA) whose initial treatment was biliary-enteric drainage (BED) or primary liver transplant (PLT). Patients with BA between 1990 and 2015 were identified using ICD-9 diagnosis codes obtained from the California Office of Statewide Health Planning and Development, which collects admission and discharge dates, patient demographics, diagnoses, and procedure codes from >6,000 health care facilities licensed by the California Department of Public Health, including 450 hospitals. Patients without any documented operative intervention by 5 years of age were excluded. Identified patient files were then linked to the Death Statistical Master File maintained by the California Department of Public Health. The primary predictor variable was the type of initial treatment among patients with BA, categorized as BED or PLT and determined using ICD-9 codes. Patients who underwent BED were classified further as only BED if they did not undergo any further procedures or as salvage liver transplant (SLT) if they eventually received a liver transplant after BED. The primary outcome was overall survival from the time of first procedure to the last follow-up or death. Investigators used Kaplan-Meier curves to assess overall survival among patients who underwent BED and PLT, as well as patients who underwent PLT and SLT. Hazard ratios (HRs) were used to compare survival curves starting 6 months after the initial procedure. A sensitivity analysis of survival outcomes before and after 2002 was also performed because there was a change in liver allocation to a model for end-stage liver disease and pediatric end-stage liver disease in 2002. There were 626 patients included in the analysis, 313 of whom underwent BED and 313 of whom underwent PLT. Survival rates among patients who underwent PLT (vs BED) were higher at 1, 5, 10, and 15 years, corresponding to a reduced risk of mortality with PLT compared to that with BED (HR, 0.19; 95% CI, 0.08–0.42). When comparing survival only among patients who underwent PLT and SLT, PLT was also associated with reduced risk of mortality (HR, 0.43; 95% CI, 0.25–0.76). When comparing survival before and after 2002, there was no survival difference between patients who underwent BED and PLT before 2002. However, after 2002, patients who underwent PLT (vs BED) had reduced mortality (HR, 0.16; 95% CI, 0.05–0.54), even after accounting for patients who underwent SLT. Investigators conclude that long-term survival is superior with PLT, compared to BED, in children with BA. Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. BA remains the leading indication for liver transplants in children. (See AAP Grand Rounds, 2017;38[4]:40.1 ) BED has historically been... You do not currently have access to this content.