Living donor liver transplantation for biliary atresia: An analysis of 2085 cases in the registry of the Japanese Liver Transplantation Society

• DOI: 10.1111/ajt.14489
• Publication Date: 2017-09-10T11:16:37Z
• Authors: Mureo Kasahara; Koji Umeshita; Seisuke Sakamoto; Akinari Fukuda; Hiroyuki Furukawa; Shotaro Sakisaka; Eiji Kobayashi; Eiji Tanaka; Yukihiro Inomata; Seiji Kawasaki; Mitsuo Shimada; Norihiro Kokudo; Hiroto Egawa; Hideki Ohdan; Shinji Uemoto
• Keywords: Adult; Graft Rejection; Male; Adolescent; Incidence; Graft Survival; Middle Aged; Prognosis; Liver Transplantation; 3. Good health; Survival Rate; Young Adult; 03 medical and health sciences; Postoperative Complications; 0302 clinical medicine; Biliary Atresia; Risk Factors; Living Donors; Humans; Female; Registries; Aged; Follow-Up Studies

Biliary atresia (BA) is the most common indication for liver transplantation (LT) in pediatric population. This study analyzed the comprehensive factors that might influence the outcomes of patients with BA who undergo living donor LT by evaluating the largest cohort with the longest follow-up in the world. Between November 1989 and December 2015, 2,085 BA patients underwent LDLT in Japan. There were 763 male and 1,322 female recipients with a mean age of 5.9 years and body weight of 18.6 kg. The 1-, 5-, 10-, 15-, and 20-year graft survival rates for the BA patients undergoing LDLT were 90.5%, 90.4%, 84.6%, 82.0%, and 79.9%, respectively. The donor body mass index, ABO incompatibility, graft type, recipient age, center experience, and transplant era were found to be significant predictors of the overall graft survival. Adolescent age (12 to <18 years) was associated with a significantly worse long-term graft survival rate than younger or older ages. We conclude that LDLT for BA is a safe and effective treatment modality that does not compromise living donors. The optimum timing for LT is crucial for a successful outcome, and early referral to transplantation center can improve the short-term outcomes of LT for BA. Further investigation of the major cause of death in liver transplanted recipients with BA in the long-term is essential, especially among adolescents.