title: The impact of hepatic portoenterostomy on liver transplantation for the treatment of biliary atresia: early failure adversely affects outcome.
abstract: The most common indication for pediatric LTx is biliary atresia with failed HPE, yet the effect of previous HPE on the outcome after LTx has not been well characterized. We retrospectively reviewed a single-center experience with 134 consecutive pediatric liver transplants for the treatment of biliary atresia from 1 May 1995 to 28 April 2008. Of 134 patients, 22 underwent LTx without prior HPE (NPE), while 112 patients underwent HPE first. HPE patients were grouped into EF, defined as need for LTx within the first year of life, and LF, defined as need for LTx beyond the first year of life. NPE and EF groups differed significantly from the LF group in age, weight, PELD, and ICU status (p < 0.05) with NPE having the highest PELD and ICU status. Patients who underwent salvage LTx after EF following HPE had a significantly higher incidence of post-operative bacteremia and septicemia (p < 0.05), and subsequently lower survival rates. One-year patient survival and graft survival were as follows: NPE 100%, EF 81%, and LF 96% (p < 0.05); and NPE 96%, EF 79%, and LF 96% (p < 0.05). Further investigation into the optimal treatment of biliary atresia should focus on identifying patients at high risk of EF who may benefit from proceeding directly to LTx given the increased risk of post-LTx bacteremia, sepsis, and death after failed HPE.
authors.affiliation: Department of Surgery, University of Southern California, Los Angeles, CA 90033, USA. alexopou@health.usc.edu
authors.forename: Sophoclis P
authors.initials: SP
authors.lastname: Alexopoulos
authors.forename: Melanie
authors.initials: M
authors.lastname: Merrill
authors.forename: Cindy
authors.initials: C
authors.lastname: Kin
authors.forename: Lea
authors.initials: L
authors.lastname: Matsuoka
authors.forename: Fred
authors.initials: F
authors.lastname: Dorey
authors.forename: Waldo
authors.initials: W
authors.lastname: Concepcion
authors.forename: Carlos
authors.initials: C
authors.lastname: Esquivel
authors.forename: Andrew
authors.initials: A
authors.lastname: Bonham
mesh_terms: D000293:Adolescent; D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016031:Liver Transplantation / Q000401:mortality; D011171:Portoenterostomy, Hepatic; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology / Q000209:etiology; D013530:Surgical Wound Infection / Q000453:epidemiology; D015996:Survival Rate; D017211:Treatment Failure; D016896:Treatment Outcome