title: Liver transplant for biliary atresia is associated with a worse outcome - Myth or fact?
abstract: BACKGROUND
  Liver transplant for biliary atresia (BA) has been reported to be associated with worse outcome, but this remains controversial. The objective of this study is to compare the outcomes of BA and non-BA recipients.
  
  
  METHODS
  Recipients with age <18years were reviewed except cases of retransplantation. Intratransplant and posttransplant complications as well as survivals were evaluated.
  
  
  RESULTS
  119 patients, with median follow-up period 8.5years, were studied (DDLT=33; LDLT=86/M:F=56:63), and 68% (n=81) were BA patients. While demographic data were comparable between two groups of recipients, BA patients had a worse pretransplant PELD/MELD score (15.2 vs 4.0, p=0.021). Transplantation takes a longer time in the BA group (580min vs 400min, p=0.065) with more blood loss (720ml vs 500ml, p=0.072). The incidence of transplant-related complications was 30.3% (36/119) (Table 1). There was no significant difference between incidences of vascular complication, but biliary complication was more common in the BA group. Overall, the survivals between the two groups were comparable.
  
  
  CONCLUSIONS
  Liver transplant is an effective surgical treatment for BA patients. When compared to other indications, results are not inferior. Previous Kasai operation is not necessarily associated with adverse outcomes.
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Patrick Ho Yu
authors.initials: PH
authors.lastname: Chung
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: Kenneth Kak Yuen
authors.initials: KK
authors.lastname: Wong
authors.affiliation: Division of Liver Transplantation, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
authors.forename: See Ching
authors.initials: SC
authors.lastname: Chan
authors.affiliation: Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong. Electronic address: paultam@hku.hk.
authors.forename: Paul Kwong Hang
authors.initials: PK
authors.lastname: Tam
mesh_terms: D000293:Adolescent; D001656:Biliary Atresia / Q000601:surgery*; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D016031:Liver Transplantation; D008297:Male; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
keywords: Biliary atresia; Kasai operation; Liver transplant