Liver transplantation for biliary atresia: A single-center study from mainland China.
OBJECTIVE
To summarize our single-center experience with liver transplantation (LT) for biliary atresia (BA).


METHODS
From October 2006 to December 2012, 188 children with BA were analyzed retrospectively. The stage I group (from October 2006 to December 2010) comprised the first 74 patients, and the stage II group (from January 2011 to December 2012) comprised the remaining 114 patients. Finally, 123 liver transplants were performed in 122 (64.9%) patients, whereas 66 patients did not undergo LT due to denial by their parents or lack of suitable liver grafts. The selection of graft types depended on the patients' clinical status and whether a suitable living donor was available. The characteristics of patients in stages I and II were described, and the surgical outcomes of LT recipients were compared between the two stages. The Kaplan-Meier method was used to estimate the cumulative patient and graft survival rates, and the equality of survival distributions was evaluated using the log-rank test.


RESULTS
The 188 children consisted of 102 boys and 86 girls. Their ages ranged from 3 to 144 mo with a median of 8 mo. One hundred and fifteen (61.2%) patients were born in rural areas. Comparing stage I and stage II patients, the proportion of patients referred by pediatricians (43.2% vs 71.1%, respectively; P < 0.001) and the proportion of patients who previously received a Kasai procedure (KP) (32.4% vs 44.7%, respectively; P = 0.092) obviously increased, and significantly more parents were willing to treat their children with LT (73% vs 86%, respectively; P = 0.027). Grafts from living donors (102/122, 83.6%) were the most commonly used graft type. Surgical complications (16/25, 64.0%) were the main reason for posttransplant mortality. Among the living donor liver transplantation recipients (n = 102), the incidence of surgical complications was significantly reduced (34.1% vs 15.5%, respectively; P = 0.029) and survival rates of patients and grafts were greatly improved (81.8% vs 89.7%, respectively, at 1 year; 75.0% vs 87.8%, respectively, at 3 years; P = 0.107) from stage I to stage II.


CONCLUSIONS
The status of surgical treatments for BA has been changing in mainland China. Favorable midterm outcomes after LT were achieved as centers gained greater technical experience.
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Qi-Gen
QG
Li
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Ping
P
Wan
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Jian-Jun
JJ
Zhang
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Qi-Min
QM
Chen
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Xiao-Song
XS
Chen
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Long-Zhi
LZ
Han
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China.
Qiang
Q
Xia
D001656:Biliary Atresia / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D002681:China; D016208:Databases, Factual; D005260:Female; D006085:Graft Survival; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution; D008297:Male; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
Biliary atresia; Kasai; Liver transplantation; Living donor; Pediatric; Survival