title: Effect of repeat Kasai hepatic portoenterostomy on pediatric live-donor liver graft for biliary atresia.
abstract: OBJECTIVE
  Treatment for patients with biliary atresia is a Kasai hepatic portoenterostomy; however, the efficacy of repeat Kasai hepatic portoenterostomy is unclear. This study sought to examine the effect of a prior Kasai hepatic portoenterostomy, especially a repeat Kasai hepatic portoenterostomy, on the outcomes of living-donor liver transplant.
  
  
  METHODS
  One hundred twenty-six of 170 children that underwent a living-donor liver transplant between May 2001, and March 2010, received a living-donor liver transplant for biliary atresia. These patients were divided into 2 groups according to the number of previous portoenterostomies: 1 (group A, n=100) or 2 or more Kasai hepatic portoenterostomies (group B, n=26). Portoenterostomy was performed twice in 24 patients in group B, 3 times in 1, and 4 times in 1. Preoperative, operative factors, mortality, morbidity, and survival rates were examined and compared between groups.
  
  
  RESULTS
  The surgical factors such as operative time, blood loss per weight, cold ischemia time, and weight of the native liver were significantly greater in group B than they were in group A. The patient survival rates were comparable in the 2 groups (94.5% in group A and 93.3% in group B), and the difference was not statistically significant. No statistically significant difference was observed between the groups with regard to vascular complications, biliary complications, and other factors including postoperative variables. Bowel perforation requiring surgical repair was more frequent in group B than it was in group A.
  
  
  CONCLUSIONS
  Repeat Kasai hepatic portoenterostomy might have a negative effect on patients who undergo living-donor liver transplant for biliary atresia patients with potential lethal complications such as bowel perforation. More biliary atresia patients could have a liver transplant, with improved survival and better life expectancy, if they have inadequate biliary drainage after the initial Kasai hepatic portoenterostomy.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, Yakushiji, Shimotsuke-shi, Tochigi, Japan. turahashi@jichi.ac.jp
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
mesh_terms: D000367:Age Factors; D001656:Biliary Atresia / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004322:Drainage; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome