Pediatric Liver Transplantation, Comparative Outcomes for Patients with Biliary Atresia

Abstract

Introduction: Orthotropic Liver Transplantation (OLT) is an effective therapeutic option to the end-stage liver disease treatment. In pediatrics, Biliary Atresia (BA) is the most frequent etiology. It has been reported that these patients would have a worse pre-transplant clinical condition, compared to other etiologies recipients; all associated with a major technical difficulty, which would result in major perioperative morbidity. Our aim is to develop an analysis of OLT due to BA outcomes versus other etiologies (Non-BA). Materials and Methods:We retrospectively analyzed cases of transplant patients in our center between 2008 and2015. Patients were managed according to our Hospital established protocols, which provide criteria for enlistment, stay in Intensive Care Unit (ICU), diagnosis and management of complications and medical discharge. This analysis was developed to two main groups: BA and Non-BA, and also to statistically significant demographic variables subgroups: Living Donor (LD)/ Diseased Donor (DD)/ Reduced Grafts (RG)/ Complete Grafts (CG).The statistical analysis was made with the chi-square test and the Mann-Whitney test; graft survival and patients are illustrated in Kaplan-Meier method and compared with log-rank test. The p value ≤0.05 was considered statistically significant.Results: 100 OLT were carried out between 2008 and 2015. 84 patients qualified for the study, and 16 re-transplants were excluded. 43 patients (51%) were with BA. The median age was 23 months (6-156) in BA, and 57 months in Non-BA. The 35% received grafts from a DD (15/43) in BA, and the 73% in Non-BA (30/41), p ≤ 0.05, reduced grafts in 79% (34/43) of BA and a 46.3% in p ≤ 0.05 (19/41). The red blood cells intra-operative use, operating time and days of stay in the ICU were similar. The Biliary and vascular complications frequency (14% vs. 7%) was higher in the transplant group of BA, without reaching statistical significance. In the subgroups analysis, a statistical significance was proved to the major use of red blood cells in reduced grafts p≤ 0.05. The graft of one year and 5 years, as well as patients survival, were similar. Conclusion:We demonstrate that the overall outcome intra-operative and postoperative in our series is similar, regardless of etiology. Although there was a higher rate of biliary complication in transplant by BA, this was not reflected in the long-term graft survival.