title: Outcomes of liver transplantation for end-stage biliary disease: A comparative study with end-stage liver disease.
abstract: OBJECTIVE
  To evaluate the outcomes of patients with end-stage biliary disease (ESBD) who underwent liver transplantation, to define the concept of ESBD, the criteria for patient selection and the optimal operation for decision-making.
  
  
  METHODS
  Between June 2002 and June 2014, 43 patients with ESBD from two Chinese organ transplantation centres were evaluated for liver transplantation. The causes of liver disease were primary biliary cirrhosis (n = 8), cholelithiasis (n = 8), congenital biliary atresia (n = 2), graft-related cholangiopathy (n = 18), Caroli's disease (n = 2), iatrogenic bile duct injury (n = 2), primary sclerosing cholangitis (n = 1), intrahepatic bile duct paucity (n = 1) and Alagille's syndrome (n = 1). The patients with ESBD were compared with an end-stage liver disease (ESLD) case control group during the same period, and the potential prognostic values of multiple demographic and clinical variables were assessed. The examined variables included recipient age, sex, pre-transplant clinical status, pre-transplant laboratory values, operation condition and postoperative complications, as well as patient and allograft survival rates. Survival analysis was performed using Kaplan-Meier curves, and the rates were compared using log-rank tests. All variables identified by univariate analysis with P values < 0.100 were subjected to multivariate analysis. A Cox proportional hazard regression model was used to determine the effect of the study variables on outcomes in the study group.
  
  
  RESULTS
  Patients in the ESBD group had lower model for end-stage liver disease (MELD)/paediatric end-stage liver disease (PELD) scores and a higher frequency of previous abdominal surgery compared to patients in the ESLD group (19.2 ± 6.6 vs 22.0 ± 6.5, P = 0.023 and 1.8 ± 1.3 vs 0.1 ± 0.2, P = 0.000). Moreover, the operation time and the time spent in intensive care were significantly higher in the ESBD group than in the ESLD group (527.4 ± 98.8 vs 443.0 ± 101.0, P = 0.000, and 12.74 ± 6.6 vs 10.0 ± 7.5, P = 0.000). The patient survival rate in the ESBD group was not significantly different from that of the ESBD group at 1, 3 and 5 years (ESBD: 90.7%, 88.4%, 79.4% vs ESLD: 84.9%, 80.92%, 79.0%, χ(2) = 0.194, P = 0.660). The graft-survival rates were also similar between the two groups at 1, 3 and 5 years (ESBD: 90.7%, 85.2%, 72.7% vs ESLD: 84.9%, 81.0%, 77.5%, χ(2) = 0.003, P = 0.958). Univariate analysis identified MELD/PELD score (HR = 1.213, 95%CI: 1.081-1.362, P = 0.001) and bleeding volume (HR = 0.103, 95%CI: 0.020-0.538, P = 0.007) as significant factors affecting the outcomes of patients in the ESBD group. However, multivariate analysis revealed that MELD/PELD score (HR = 1.132, 95%CI: 1.005-1.275, P = 0.041) was the only negative factor that was associated with short survival time.
  
  
  CONCLUSIONS
  MELD/PELD criteria do not adequately measure the clinical characteristics and staging of ESBD. The allocation system based on MELD/PELD criteria should be re-evaluated for patients with ESBD.
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Yan-Hua
authors.initials: YH
authors.lastname: Lai
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Wei-Dong
authors.initials: WD
authors.lastname: Duan
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Yu
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Sheng
authors.initials: S
authors.lastname: Ye
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Nian-Jun
authors.initials: NJ
authors.lastname: Xiao
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Dong-Xin
authors.initials: DX
authors.lastname: Zhang
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Huang
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Zhan-Yu
authors.initials: ZY
authors.lastname: Yang
authors.affiliation: Yan-Hua Lai, Wei-Dong Duan, Qiang Yu, Sheng Ye, Nian-Jun Xiao, Dong-Xin Zhang, Zhi-Qiang Huang, Jia-Hong Dong, Hospital and Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
authors.forename: Jia-Hong
authors.initials: JH
authors.lastname: Dong
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002681:China; D003661:Decision Support Techniques; D058625:End Stage Liver Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018579:Patient Selection; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Complication; End-stage biliary disease; Liver transplantation; Model for end-stage liver disease; Paediatric end-stage liver disease