title: The pre-Kasai procedure in living donor liver transplantation for children with biliary atresia.
abstract: BACKGROUND
  Biliary atresia (BA) is a major cause of chronic cholestasis, a fatal disorder in infants. This study was undertaken to evaluate the safety and effectiveness of primary living donor liver transplantation (LDLT) in comparison with the traditional first-line treatment, the Kasai procedure.
  
  
  METHODS
  We assessed 28 children with BA at age of less than two years (3-21.3 months) who had undergone LDLT in two hospitals in Southwest China during the period of 2008-2011. Eighteen children who had had primary LDLT were included in a primary LDLT group, and ten children who had undergone the Kasai operation in a pre-Kasai group. All patients were followed up after discharge from the hospital. The records of the BA patients and donors were reviewed.
  
  
  RESULTS
  The time of follow-up ranged 12-44.5 months with a median of 31 months. The 30-day and 1-year survival rates were 85.7% and 78.6%, respectively. There was no significant difference in the 30-day or 1-year survival between the two groups (83.3% vs 90% and 77.8% vs 80%, P>0.05). The main cause of death was hepatic artery thrombosis. There were more patients with complications who required intensive medical care or re-operation in the pre-Kasai group (8, 80%) than in the primary LDLT group (9, 50%) (P=0.226). But no significant differences were observed in operating time (9.3 vs 8.9 hours, P=0.77), intraoperative blood loss (208.6 vs 197.0 mL, P=0.84) and blood transfusion (105.6 vs 100.0 mL, P=0.91) between the two groups. The durations of ICU and hospital stay in the primary LDLT group and pre-Kasai group were 180.4 vs 157.7 hours (P=0.18) and 27 vs 29 days (P=0.29), respectively.
  
  
  CONCLUSIONS
  Primary LDLT is a safe and efficient management for young pediatric patients with BA. Compared with the outcome of LDLT for patients receiving a previous Kasai operation, a similar survival rate and a low rate of re-operation and intensive medical care for patients with BA can be obtained.
authors: Liver Transplantation Division, Department of Surgery, West China Hospital, Sichuan University, Chengdu 610041, China.
authors: Qiao
authors: Q
authors: Wang
authors: Lu-Nan
authors: LN
authors: Yan
authors: Ming-Man
authors: MM
authors: Zhang
authors: Wen-Tao
authors: WT
authors: Wang
authors: Ji-Chun
authors: JC
authors: Zhao
authors: Cong-Lun
authors: CL
authors: Pu
authors: Ying-Cun
authors: YC
authors: Li
authors: Quan
authors: Q
authors: Kang
mesh_terms: D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data; D013927:Thrombosis / Q000401:mortality; D016896:Treatment Outcome