Observational Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2015; 21(32): 9638-9647
Published online Aug 28, 2015. doi: 10.3748/wjg.v21.i32.9638
Liver transplantation for biliary atresia: A single-center study from mainland China
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Qi-Min Chen, Xiao-Song Chen, Long-Zhi Han, Qiang Xia
Qi-Gen Li, Ping Wan, Jian-Jun Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Qi-Min Chen, Department of Pediatric Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Author contributions: Li QG and Wan P contributed equally to this work; Xia Q was the guarantor and designed the study; Wan P and Li QG participated in the acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Zhang JJ, Chen QM, Chen XS, and Han LZ revised the article critically for important intellectual content.
Supported by Key Joint Research Program of Shanghai Health Bureau, No. 2013ZYJB0001; and a subtopic of Scientific and Technological Innovation and Action Project of Shanghai Science and Technology Commission, No. 14411950404.
Institutional review board statement: The study was reviewed and approved by the Science and Research Office of Ren Ji Hospital (Shanghai).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Qiang Xia, Professor, Chief, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630 Dongfang Road, Shanghai 200127, China. xiaqiang@medmail.com.cn
Telephone: +86-21-68383775 Fax: +86-21-58737232
Received: March 15, 2015
Peer-review started: March 15, 2015
First decision: April 13, 2015
Revised: May 10, 2015
Accepted: June 9, 2015
Article in press: June 10, 2015
Published online: August 28, 2015
Abstract

AIM: To summarize our single-center experience with liver transplantation (LT) for biliary atresia (BA).

METHODS: From October 2006 to December 2012, 188 children with BA were analyzed retrospectively. The stage I group (from October 2006 to December 2010) comprised the first 74 patients, and the stage II group (from January 2011 to December 2012) comprised the remaining 114 patients. Finally, 123 liver transplants were performed in 122 (64.9%) patients, whereas 66 patients did not undergo LT due to denial by their parents or lack of suitable liver grafts. The selection of graft types depended on the patients’ clinical status and whether a suitable living donor was available. The characteristics of patients in stages I and II were described, and the surgical outcomes of LT recipients were compared between the two stages. The Kaplan-Meier method was used to estimate the cumulative patient and graft survival rates, and the equality of survival distributions was evaluated using the log-rank test.

RESULTS: The 188 children consisted of 102 boys and 86 girls. Their ages ranged from 3 to 144 mo with a median of 8 mo. One hundred and fifteen (61.2%) patients were born in rural areas. Comparing stage I and stage II patients, the proportion of patients referred by pediatricians (43.2% vs 71.1%, respectively; P < 0.001) and the proportion of patients who previously received a Kasai procedure (KP) (32.4% vs 44.7%, respectively; P = 0.092) obviously increased, and significantly more parents were willing to treat their children with LT (73% vs 86%, respectively; P = 0.027). Grafts from living donors (102/122, 83.6%) were the most commonly used graft type. Surgical complications (16/25, 64.0%) were the main reason for posttransplant mortality. Among the living donor liver transplantation recipients (n = 102), the incidence of surgical complications was significantly reduced (34.1% vs 15.5%, respectively; P = 0.029) and survival rates of patients and grafts were greatly improved (81.8% vs 89.7%, respectively, at 1 year; 75.0% vs 87.8%, respectively, at 3 years; P = 0.107) from stage I to stage II.

CONCLUSION: The status of surgical treatments for BA has been changing in mainland China. Favorable midterm outcomes after LT were achieved as centers gained greater technical experience.

Keywords: Biliary atresia, Liver transplantation, Kasai, Living donor, Pediatric, Survival

Core tip: Biliary atresia (BA) accounts for at least 50% of the liver transplants performed in pediatric patients. However, in mainland China, various social, cultural and financial factors are responsible for a low diagnostic rate or a delayed Kasai procedure for children with BA. Pediatric liver transplantation has been progressing immensely in mainland China. In this study, we analyzed our single-center data of children with BA between 2006 and 2012, representing the largest series of BA patients in mainland China ever reported. Based on these data, socioeconomic backgrounds that impact the current status of surgical treatments for BA in mainland China were introduced.