Living‐related liver transplantation for biliary atresia

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Abstract
We reviewed our initial experience of 29 living‐related liver transplantations (LRLT) for children with biliary atresia in terms of postoperative complications and management to analyze the factors that may influence the outcome. All patients underwent an initial portoenterostomy at 17–134 days of age. The age distribution at the time of LRLT ranged from 6 months to 12 years, following revised portoenterostomy 0 to 3 times, and with (n = 5) or without enteric stoma (n = 24). Living‐related donors provided the partial liver grafts weighing 170 to 630 g according to recipient size. Twenty‐six of the 29 recipients are alive and well with follow‐up between 1 and 27 (mean = 14) months. Three patients died of extrahepatic complications including aspiration asphyxia. Candida infection and lymphoproliferative disorder. Four of 5 children with enteric stoma had 9 incidences of postoperative complication, while only 4 incidences occurred in 4 out of 24 children without stoma (p=0.007). Children hospitalized at the time of transplantation seemed to have early postoperative complications more frequently than home‐bound children (p=0.06). The present results indicated that LRLT could offer satisfactory outcome for children in whom repealed Kasai's operation could not attain adequate biliary diversion and for those who developed cirrhosis despite good initial bile drainage. LRLT is not only a promising modality to rescue children with biliary atresia in countries where brain death donors are unavailable but also offers the advantage of optimal timing of surgery for these children at various ages, since it is independent of cadaver graft availability in any region of the world.