Pretransplant risk factors and optimal timing for living-related liver transplantation in biliary atresia: experience of one Japanese children's hospital and transplantation center.
OBJECTIVE
Although living-related liver transplantation (LRLT) is effective for patients with biliary atresia (BA) after a failed Kasai operation, the pretransplant factors affecting post-LRLT mortality and the optimal timing of the procedure remain unclear.


METHODS
A retrospective review of 27 patients with BA after a failed Kasai operation (median age, 22 months; range, 6-237 months) who received LRLT from 1994 to 2005 was done. The clinical characteristics at the time of the pre-LRLT assessment of those who did and did not survive were compared. A simple regression analysis and receiver operating characteristic analysis were done to correlate the clinical data.


RESULTS
Among the 27 patients, 4 patients died within 1 year post-LRLT. The significant factors affecting posttransplant death were hepatopulmonary syndrome (HPS), age at LRLT, and graft-to-recipient weight ratio. The arterial blood gas analysis of HPS patients showed that there was a significant negative correlation between the SaO(2) value on room air and the intrapulmonary shunt ratio. The receiver operating characteristic analysis of age at LRLT showed that the optimal cutoff point was 103 months of age.


CONCLUSIONS
Older children with HPS or a lower graft-to-recipient weight ratio are not ideal candidates for LRLT. The correlation between the shunt ratio and SaO(2) suggests that HPS could be detected early using pulse oximetry.
Okamoto
Tatsuya
T
Department of Pediatric Surgery, Kobe Children's Hospital, Kobe 654-0081, Japan. okamoto_kch@hp.pref.hyogo.jp
Yokoi
Akiko
A
Okamoto
Shinya
S
Takamizawa
Shigeru
S
Satoh
Shiiki
S
Muraji
Toshihiro
T
Uemoto
Shinji
S
Nishijima
Eiji
E
D000046:Academic Medical Centers; D000367:Age Factors; D001656:Biliary Atresia / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D002675:Child, Preschool; D005190:Family; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D017052:Hospital Mortality / Q000639:trends; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007564:Japan; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D019520:Living Donors; D008297:Male; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D011379:Prognosis; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D016896:Treatment Outcome