Living Donor Liver Transplantation for Biliary Atresia: A Single-Center Experience with First 100 Cases

Abstract

The aim of this study is to present our institutional experience in living donor liver transplantation (LDLT) as a treatment for end-stage liver disease in children with biliary atresia (BA). A retrospective review of transplant records was performed. One hundred BA patients (52 males and 48 females) underwent LDLT. The mean follow-up period was 85.5 months. The mean age was 2.4 years. The mean preoperative weight, height, and computed GFR were 12.2 kg, 82.5 cm, and 116.4 ml/min/1.73 m 2 , respectively. Twenty-seven patients were below 1 year of age, and 49 patients were below 10 kg at the time of transplantation. Ninetysix had had previous Kasai operation prior to transplant. The mean recipient operative time was 628 min. The mean recipient intraoperative blood loss was 176 ml. Thirty-five did not require blood or blood component transfusion. The left lateral segment (64) was the most common type of graft used. There were 27 operative complications which included 3 reoperations for postoperative bleeding, 9 portal vein, 4 hepatic vein, 4 hepatic artery, and 7 biliary complications. There was one in-hospital mortality and one retransplantation. The overall rejection rate was 20%. The overall mortality rate was 3%. The 6-month, 1-year and 5-year actual recipient survival rates were 99%, 98% and 98%, respectively.

Living donor liver transplantation with body-weight more or less than 10 kilograms

“…We have previously reported that the average change in core temperature during an LDLT for pediatric patients weighing less than 10 kg is significantly different from that in heavier children [5] . Furthermore, a lower survival rate for lower weight children was reported by Arnon et al [3] , and according to other studies, this poorer survival results from higher risks of perioperative vascular complications, bile duct complications and infections [4,6,7] . In pediatric kidney transplantation, the ideal body weight for a recipient has also been found to be greater than 10 kg [8] .…”

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“…19 The donor and recipient evaluation and hepatectomies for liver transplant were performed as previously described. [20][21][22] There were no transplants that had ABO incompatibility. In all right lobe transplants, the grafts were excised without the middle hepatic vein.…”

Living donor liver transplantation for hepatocellular carcinoma achieves better outcomes

“…In Asia, living donor LT (LDLT) has been emerging as the solution of organ shortage to treat HCC. At Kaohsiung Chang Gung Memorial Hospital, the first case of LDLT was performed for a pediatric patient with biliary atresia in 1994, and progressed to adult LDLT in 1999 (3). In the high endemicity of hepatitis B and C (HBV and HCV), HCC has become the most indication for LT.…”