title: Living Related Liver Transplantation for Biliary Atresia in the Last 5 years: Experience from the First Liver Transplant Program in India.
abstract: OBJECTIVE
  To study the clinical, biochemical profile and outcome of patients with biliary atresia (BA) who underwent living related liver transplantation (LRLT) at authors' institute in the last 5 y (2008-2013).
  
  
  METHODS
  Case records of the 20 patients diagnosed with biliary atresia who had undergone living related liver transplantation at authors' centre in the last 5 y were analysed.
  
  
  RESULTS
  Eighteen patients with BA with a failed Kasai procedure and 2 without a prior Kasai's portoenterostomy received a liver transplant. At a median follow up of 2 y and 6 mo, both the patient and graft survival rates were 90 %. The median age of the recipients at the time of LRLT was 8 mo and 12 (60 %) of the transplanted children were less than or equal to 1 y of age. The male-female ratio was 1.8:1. The median weight was 7.3 kg (5.8-48 kg); two thirds were less than 10 kg. The median pre-transplant total serum bilirubin (TSB) and international normalized ratio (INR) were 12.98 (0.5-48.3) mg/dl and 1.3 (1.0-3.9) respectively. All patients received a living related graft and there was no donor mortality. The median duration of postoperative ventilation was 14 h. The post-operative complications were infection (30 %), vascular complications (20 %) and acute rejection (20 %). The median duration of postoperative hospital stay was 21 d (17-42). Two patients died of combined hepatic and portal vein thrombosis in the early postoperative period. Late rejection was encountered in 1 patient and another developed chronic kidney disease necessitating a renal transplant. There were no late vascular occlusions or development of post transplant lymphoproliferative disease.
  
  
  CONCLUSIONS
  Thus, LRLT for BA with or without a prior portoenterostomy, is a feasible and successful treatment modality with good outcomes attained despite the challenges of age and size. This treatment modality is now well established in India.
authors.affiliation: Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India.
authors.forename: Smita
authors.initials: S
authors.lastname: Malhotra
authors.affiliation: Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India. anupamsibal@apollohospitals.com.
authors.forename: Anupam
authors.initials: A
authors.lastname: Sibal
authors.affiliation: Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India.
authors.forename: Vidyut
authors.initials: V
authors.lastname: Bhatia
authors.affiliation: Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India.
authors.forename: Akshay
authors.initials: A
authors.lastname: Kapoor
authors.affiliation: Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India.
authors.forename: Sarath
authors.initials: S
authors.lastname: Gopalan
authors.affiliation: Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India.
authors.forename: Swati
authors.initials: S
authors.lastname: Seth
authors.affiliation: Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India.
authors.forename: Nameet
authors.initials: N
authors.lastname: Jerath
authors.affiliation: Centre for Liver and Biliary Sciences, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Manav
authors.initials: M
authors.lastname: Wadhawan
authors.affiliation: Centre for Liver and Biliary Sciences, Indraprastha Apollo Hospital, New Delhi, India.
authors.forename: Subash
authors.initials: S
authors.lastname: Gupta
mesh_terms: D000293:Adolescent; D001656:Biliary Atresia / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007194:India; D007223:Infant; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D011183:Postoperative Complications; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Biliary atresia; India; Living related liver transplant; Survival