title: Comparison of liver transplantation outcomes in biliary atresia patients with and without prior portoenterostomy: A meta-analysis.
abstract: BACKGROUND
  Portoenterostomy is currently the standard first procedure for biliary atresia, and liver transplantation is reserved as a complementary therapy for those with late diagnosis, rapid hepatic decompensation, or failed portoenterostomy. Many previous publications have analysed the impact of prior portoenterostomy on the clinical outcomes of liver transplantation and the conclusions are discordant.
  
  
  METHODS
  PubMed and EMBASE were systematically searched for relevant articles, and studies published in Chinese were searched in the Wanfang China Medical Collections. The references of the retrieved studies were also reviewed. In addition, Google scholar was used to further confirm the literature search.
  
  
  RESULTS
  Fourteen studies were included comprising 1560 patients, of which 1190 (76.3%) received portoenterostomy. Meta-analysis did not reveal significant differences in either patient survival rate (odds ratio, 0.82) or graft survival rate (odds ratio, 1.11) over a 5-year follow-up between biliary atresia patients with and without a portoenterostomy procedure prior to liver transplantation; patients who received a prior portoenterostomy procedure had a higher risk of postoperative infection (odds ratio, 2.02).
  
  
  CONCLUSIONS
  Accumulated literature suggested that a prior portoenterostomy did not adversely affect outcomes of liver transplantation in children with biliary atresia.
authors.affiliation: Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
authors.forename: Panliang
authors.initials: P
authors.lastname: Wang
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA.
authors.forename: Pengcheng
authors.initials: P
authors.lastname: Xun
authors.affiliation: Department of Epidemiology and Biostatistics, School of Public Health-Bloomington, Indiana University, Bloomington, IN, USA. Electronic address: kahe@indiana.edu.
authors.forename: Ka
authors.initials: K
authors.lastname: He
authors.affiliation: Department of Pediatric Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Shanghai Key Laboratory of Pediatric Gastroenterology and Nutrition, Shanghai, China; Shanghai Institute of Pediatric Research, Shanghai, China. Electronic address: caiw1978@163.com.
authors.forename: Wei
authors.initials: W
authors.lastname: Cai
mesh_terms: D001656:Biliary Atresia / Q000401:mortality* / Q000601:surgery*; D002681:China; D006085:Graft Survival; D006801:Humans; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality*; D011171:Portoenterostomy, Hepatic / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Biliary atresia; Liver transplantation; Meta-analysis; Outcomes; Portoenterostomy