Protocol liver biopsy is the only examination that can detect mid-term graft fibrosis after pediatric liver transplantation

Table 1 Demographic characteristics of recipients and grafts undergoing protocol liver biopsy at two and five years after living donor liver transplantation

	PLB at two years after LDLT (n = 89)	PLB at five years after LDLT (n = 55)
Recipient characteristics at LDLT
Gender	Male 37, female 52	Male 20, female 35
Age (mo)	22 (0-234)	19 (7-198)
Body weight (kg)	10.7 (2.6-58.5)	9.7 (5.9-64.9)
Original disease	BA 63, OTCD 9, AS 4, FHF 4, CEPS 3, graft failure 2, WD 1, PSC 1, CPS1D 1, LC 1	BA 43, OTCD 3, AS 2, WD 2, FHF 1, HB 1, CF 1, CEPS 1, graft failure 1
PELD or MELD	7.4 (-9.7-39.4)	8.6 (-8.9-39.4)
Operation time	13 h 25 min (7 h 33 min-30 h 28 min)	17h 19 min (11 h 11 min-30 h 28 min)
Cold ischemic time	2 h 17 min (36 min-8 h 6 min)	2 h 06 min (25 min-16 h 19 min)
Warm ischemic time	45 min (30 min-2 h 2 min)	1 h 00 min (30 min-4 h 27 min)
Blood loss volume (mL/kg)	77.0 (3.1-585.1)	45.5 (6.7-776.2)
Transfusion volume (mL/kg)	91.3 (0.0-597.7)	68.1 (0.0-670.7)
Donor and graft characteristics at LDLT
Gender	Father; 45, mother; 44	Father; 30, mother; 25
Age (yr)	33 (23-57)	33 (23-53)
ABO compatibility	Identical; 55, compatible; 20, incompatible 14	Identical; 40, compatible; 8, incompatible 7
GV/SLV (%)	68.0 (33.0-120.9)	75.8 (35.7-121.2)
Graft type	Lateral segment; 57, left lobe; 23,	Lateral segment; 43, left lobe; 10,
	S2 monosegment; 5, left lobe + caudate; 4	left lobe + caudate; 2
Recipient and graft characteristics at PLB
Age (mo)	48 (24-259)	81 (68-257)
Body weight (kg)	15.6 (7.3-64.6)	21.4 (14.4-71.6)
Total bilirubin (mg/dL)	0.63 (0.25-3.25)	0.68 (0.26-2.55)
AST (IU/L)	30 (14-61)	27 (10-251)
ALT (IU/L)	17 (9-54)	17 (8-260)
γ-GTP (IU/L)	17 (6-440)	16 (9-510)
Hyaluronic acid (ng/mL)	21 (9-239)	17 (9-216)
IgG (mg/dL)	927 (440-2063)	1148 (475-2961)
GV/SLV (%)	90.6 (70.2-126.9)	93.0 (58.8-157.0)
Spleen volume (mL)	125 (0-892)	145 (0-692)
Trough of tacrolimus (ng/mL)	3.4 (0-10.1)	2.3 (0-15.5)

PLB: Protocol liver biopsy; LDLT: Living donor liver transplantation; BA: Biliary atresia; OTCD: Ornithine transcarbamylase deficiency; AD: Alagille syndrome; FHF: Fulminant hepatic failure; CEPS: Congenital extrahepatic portsystemic shunt; WD: Wilson disease; PSC: Primary sclerosing cholangitis; CPS1D: Carbamoyl-phosphate synthase 1 deficiency; LC: Liver cirrhosis; HB: Hepatoblastoma; CF: Cystic fibrosis; PELD: Pediatric end-stage liver disease; MELD: Model for end-stage liver disease; GV/SLV: Ratio of graft volume to standard liver volume; AST: Aspartate amino transferase; ALT: Alanine amino transferase; IgG: Immunoglobulin G.

Table 2 Risk factors for ≥ A1 and ≥ F1 of protocol liver biopsy at two years after living donor liver transplantation: univariate analysis

Variables	Incidence of ≥ A1 (%)	P value	Incidence of ≥ F1 (%)	P value
Recipient age at LDLT
< 12 mo (n = 30) vs≥ 12 mo (n = 59)	26.7 vs 23.7	0.762	36.7 vs 18.6	0.062
Recipient body weight at LDLT
< 10 kg (n = 43) vs≥ 10 kg (n = 46)	23.3 vs 26.1	0.757	27.9 vs 21.7	0.500
Original disease
Cholestatic diseases (n = 69) vs others (n = 20)	33.3 vs 38.1	0.637	33.3 vs 38.1	0.637
PELD or MELD
≥ 20 (n = 22) vs < 20 (n = 67)	22.7 vs 25.4	0.803	31.8 vs 22.4	0.374
Donor age
≥ 35 yr (n = 39) vs < 35 yr (n = 50)	23.1 vs 26.0	0.751	25.6 vs 24.0	0.858
Gender combinations between donor and recipient
Mismatch (n = 50) vs match (n = 39)	24.0 vs 25.6	0.858	22.0 vs 28.2	0.501
ABO compatibility
Incompatible (n = 14) vs others (n = 75)	21.4 vs 25.3	0.755	14.3 vs 26.7	0.324
HLA-A
Mismatch (n = 65) vs match (n = 24)	30.8 vs 8.3	0.029	27.7 vs 16.7	0.285
HLA-B
Mismatch (n = 84) vs match (n = 5)	26.2 vs 0.0	0.187	25.0 vs 20.0	0.802
HLA-DRB1
Mismatch (n = 76) vs match (n = 13)	26.3 vs 15.4	0.398	26.3 vs 15.4	0.398
Lymphocyte cross-matching
≥ 4 × (n = 7) vs negative (n = 82)	0.0 vs 26.8	0.114	28.6 vs 24.4	0.805
GV/SLV
< 40 % (n = 6) vs≥ 40 % (n = 83)	33.3 vs 24.1	0.612	16.7 vs 25.3	0.636
Graft type
Lateral segment graft (n = 57) vs others (n = 32)	21.1 vs 31.3	0.285	29.8 vs 15.6	0.136
Operation time
≥ 20 h (n = 12) vs < 20 h (n = 77)	16.7 vs 26.0	0.113	25.0 vs 24.7	0.975
Cold ischemic time
≥ 2 h (n = 49) vs < 2 h (n = 40)	32.7 vs 15.0	0.055	28.6 vs 20.0	0.351
Warm ischemic time
≥ 45 min (n = 45) vs < 45 min (n = 44)	20.0 vs 29.5	0.297	26.7 vs 22.7	0.666
Blood loss volume
≥ 100 mL/kg (n = 30) vs < 100 mL/kg (n = 59)	16.7 vs 28.8	0.209	26.7 vs 23.7	0.762
Transfusion volume
≥ 100 mL/kg (n = 41) vs < 100 mL/kg (n = 48)	22.0 vs 27.1	0.576	22.0 vs 27.1	0.576
Splenectomy
Yes (n = 7) vs No (n = 82)	42.9 vs 23.2	0.247	28.6 vs 24.4	0.805
Portal vein complications
Yes (n = 11) vs No (n = 78)	9.1 vs 26.9	0.199	27.3 vs 24.4	0.834
Hepatic arterial complications
Yes (n = 6) vs No (n = 83)	16.7 vs 25.3	0.636	33.3 vs 24.1	0.509
Hepaticojejunostomic anastomotic stricture
Yes (n = 14) vs No (n = 75)	21.4 vs 25.3	0.755	28.6 vs 24.0	0.716
Cytomegalovirus infection
Yes (n = 29) vs No (n = 60)	31.0 vs 21.7	0.337	27.6 vs 23.3	0.663
Acute cellular rejection
Yes (n = 29) vs No (n = 60)	10.3 vs 31.7	0.029	17.2 vs 28.3	0.255
Total bilirubin at PLB
≥ 0.7 mg/dL (n = 29) vs < 0.7 mg/dL (n = 60)	17.2 vs 28.3	0.255	24.1 vs 25.0	0.929
AST at PLB
≥ 30 IU/L (n = 49) vs < 30 IU/L (n = 40)	24.5 vs 25.0	0.956	34.7 vs 12.5	0.016
ALT at PLB
≥ 20 IU/L (n = 27) vs < 20 IU/L (n = 62)	40.7 vs 17.7	0.021	37.0 vs 19.4	0.075
γ-GTP at PLB
≥ 20 IU/L (n = 34) vs < 20 IU/L (n = 55)	32.4 vs 20.0	0.189	29.4 vs 21.8	0.420
Hyaluronic acid at PLB
≥ 20 ng/mL (n = 52) vs < 20 ng/mL (n = 37)	32.7 vs 13.5	0.039	23.1 vs 27.0	0.671
IgG at PLB
≥ 1200 mg/dL (n = 18) vs < 1200 mg/dL (n = 71)	27.8 vs 23.9	0.737	33.3 vs 22.5	0.343
ANA at PLB
≥ 20 × (n = 8) vs < 20 × (n = 81)	12.5 vs 25.7	0.401	12.5 vs 25.9	0.401
ASMA at PLB
≥ 20 × (n = 21) vs < 20 × (n = 68)	23.8 vs 25.0	0.913	28.6 vs 23.5	0.640
Trough of tacrolimus at PLB
≥ 3.0 ng/mL (n = 54) vs < 3.0 ng/mL (n = 32)1	25.9 vs 25.0	0.924	24.1 vs 25.0	0.924

¹Three cases which were used a cyclosporine were removed. LDLT: Living donor liver transplantation; PELD: Pediatric end-stage liver disease; MELD: Model for end-stage liver disease; GV/SLV: Ratio of graft volume to standard liver volume; PLB: Protocol liver biopsy; AST: Aspartate amino transferase; ALT: Alanine amino transferase; IgG: Immunoglobulin G; ANA: Antinuclear antibody; ASMA: Antismooth nuclear antibody.

Table 3 Risk factors for ≥ A1 and ≥ F1 of protocol liver biopsy at two and five years after living donor liver transplantation: multivariate analysis

Variables	OR	95%CI	P value
Risk factors for ≥ A1 of PLB at two years after LDLT
HLA-A mismatch
Mismatch vs match	0.46	0.145-1.479	0.194
Cold ischemic time
≥ 2 h vs < 2 h	4.15	1.164-14.789	0.028
Acute cellular rejection
Yes vs No	0.20	0.046-0.878	0.033
ALT
≥ 20 IU/L vs < 20 IU/L	4.64	1.409-15.306	0.012
Hyaluronic acid
≥ 20 ng/mL vs < 20 ng/mL	3.30	0.982-11.076	0.054
Risk factors for ≥ F1 of PLB at two years after LDLT
Recipient age
< 1 yr vs≥ 1 yr	1.54	0.506-4.706	0.446
AST
≥ 30 IU/L vs < 30 IU/L	2.68	0.775-9.238	0.120
ALT
≥ 20 IU/L vs < 20 IU/L	1.86	0.646-5.335	0.251
Risk factors for ≥A1 of PLB at five years after LDLT
Cold ischemic time
≥ 2 h vs < 2 h	2.94	0.778-11.140	0.112
Acute cellular rejection
Yes vs No	2.26	0.728-7.035	0.158
Risk factor for ≥ F1 of PLB at five years after LDLT
Acute cellular rejection
Yes vs No	2.75	0.876-8.637	0.083

PLB: Protocol liver biopsy; LDLT: Living donor liver transplantation; ALT: Alanine amino transferase; AST: Aspartate amino transferase.

Table 4 Clinical and hitopathological findings of cases with ≥ A2 or ≥ F2 of protocol liver biopsy at two or five years after living donor liver transplantation

Case	Original disease	Age at PLB/sex	Previous ACR	Post-transplant complications	IS at PLB	Tac trough at PLB	ALT/HA at PLB	A/F at PLB	IS at follow-up biopsy	A/F at follow-up biopsy
PLB at two years after LDLT
1	OTCD	71/female	-	-	Tac (3.0)	2.5	12/35	2/1	Tac (1.0)/MMF (400)	1/1
2	OTCD	164/female	-	BDS	Tac (2.0)/MMF (1000)	5.2	34/13	2/1	Tac (2.0)/MMF (1000)	1/0
3	OTCD	44/male	-	-	Tac (0.8)/MMF (250)	2	25/< 9	2/2	Tac (0.8)/MMF (500)	N.E.
PLB at five years after LDLT
4	BA	70/female	+	Bowel perforation	Tac (0.6)	1.1	22/13	2/2	Tac (2.0)/MMF (1000)	0/0
5	BA	118/female	-	-	Tac (1.0)	2.3	20/24	2/2	Tac (2.0)/MMF (1000)	1/0
6	BA	70/female	+	HAT/IHBDS	Tac (0.8)/MMF(500)	3.6	32/28	1/2	Tac (2.0)/MMF (500)	1/1
7	BA	71/female	-	CMV-I	Tac (0.4)	0	16/< 9	2/2	Tac (1.6)	N.E.
8	FHF	83/female	-	-	Tac (2.0)/MMF (500)	2.2	26/< 9	1/2	Tac (2.8)/MMF (500)	N.E.
9	BA	77/female	-	CMV-I	Tac (0.4)	2.6	14/29	2/3	Tac (0.8)	0/1
10	BA	84/female	+	Fungal infection	Tac (0.4)	2.1	26/11	2/2	Tac (0.4),MMF (500)	1/1
11	BA	89/male	+	PVS	Tac (1.6)/MP (4.0)/MMF (1500)	2.2	12/17	2/2	Tac (1.6)/MP (2.0)/MMF (1500)	1/1
12	BA	174/male	-	BDS	Tac (3.0)	2.3	16/20	1/2	Tac (4.0)	0/1
13	BA	69/female	+	CMV-I	Tac (1.6)	2.8	18/< 9	1/2	Tac (2.0)/MMF (1000)	0/1
14	BA	84/male	-	HVS	Tac (2.0)/MP (1.0)/MMF (1000)	5.6	12/23	1/2	Tac (2.0)/MP (1.0)/MMF (1000)	N.E.

PLB: Protocol liver biopsy; LDLT: Living donor liver transplantation; ACR: Acute cellular rejection; IS: Immunosuppressants; Tac: Tacrolimus; ALT: Alanine amino transferase; HA: Hyaluronic acid; A: Activity; F: Fibrosis; OTCD: Ornithine transcarbamylase deficiency; BA: Biliary atresia; FHF: Fulminant hepatic failure; BDS: Biliary duct anastomotic stenosis; HAT: Hepatic artery thrombosis; IHBDS: Intrahepatic biliary duct stenosis; CMV-I: Cytomegalovirus infection; PVS: Portal vein stenosis; HVS: Hepatic vein stenosis; MMF: Mycophenolate mofetil: MP: Methylprednisolone.

Table 5 Risk factors for ≥ A1 and ≥ F1 of protocol liver biopsy at five years after living donor liver transplantation: univariable analysis

Variables	Incidence of≥A1 (%)	P-value	Incidence of≥F1 (%)	P-value
Recipient age at LDLT
< 12 mo (n = 18) vs≥ 12 mo (n = 37)	38.9 vs 51.4	0.385	38.9 vs 32.4	0.637
Recipient body weight at LDLT
< 10 kg (n = 29) vs≥ 10 kg (n = 26)	41.4 vs 53.8	0.355	55.0 vs 30.8	0.577
Original disease
Cholestatic diseases (n = 45) vs others (n = 10)	46.7 vs 50.0	0.850	35.6 vs 33.3	0.738
PELD or MELD
≥ 20 (n = 12) vs < 20 (n = 43)	41.7 vs 48.8	0.660	41.7 vs 52.6	0.558
Donor age
≥ 35 yr (n = 22) vs < 35 yr (n = 33)	40.9 vs 51.5	0.440	36.4 vs 33.3	0.816
Gender combinations between donor and recipient
Mismatch (n = 30) vs match (n = 25)	53.3 vs 40.0	0.324	40.0 vs 28.0	0.352
ABO compatibility
incompatible (n = 7) vs others (n = 48)	42.9 vs 47.9	0.802	28.6 vs 35.4	0.722
HLA-A
Mismatch (n = 41) vs match (n = 14)	51.2 vs 35.7	0.316	39.0 vs 21.4	0.232
HLA-B
Mismatch (n = 52) vs match (n = 3)	48.1 vs 33.3	0.619	32.7 vs 66.7	0.229
HLA-DRB1
Mismatch (n = 47) vs match (n = 8)	51.1 vs 25.0	0.172	36.2 vs 25.0	0.539
Lymphocyte cross-matching
≥ 4 × (n = 16) vs negative (n = 39)	31.3 vs 53.8	0.127	18.8 vs 41.0	0.115
GV/SLV
< 40 % (n = 2) vs≥ 40 % (n = 53)	0.0 vs 49.1	0.173	0.0 vs 35.8	0.295
Graft type
Lateral segment graft (n = 43) vs others (n = 12)	51.2 vs 33.3	0.274	39.5 vs 16.7	0.141
Operation time
≥ 20 h (n = 16) vs < 20 h (n = 39)	37.5 vs 51.3	0.352	31.3 vs 35.9	0.742
Cold ischemic time
≥ 2 h (n = 40) vs < 2 h (n = 15)	55.0 vs 26.7	0.061	40.0 vs 20.0	0.165
Warm ischemic time
≥ 1 h (n = 42) vs < 1 h (n = 13)	42.9 vs 61.5	0.238	31.0 vs 46.2	0.314
Blood loss volume
≥ 150 mL/kg (n = 11) vs < 150 mL/kg (n = 44)	27.3 vs 52.3	0.137	27.3 vs 36.4	0.57
Transfusion volume
≥ 100 mL/kg (n = 15) vs < 100 mL/kg (n = 40)	40.0 vs 50.0	0.508	40.0 vs 32.5	0.603
Splenectomy
Yes (n = 2) vs No (n = 53)	100.0 vs 45.3	0.128	0.0 vs 35.8	0.295
Portal vein complications
Yes (n = 9) vs No (n = 46)	44.4 vs 47.8	0.852	33.3 vs 34.8	0.933
Hepatic arterial complications
Yes (n = 4) vs No (n = 51)	25.0 vs 49.0	0.354	25.0 vs 35.3	0.677
Hepaticojejunostomic anastomotic stricture
Yes (n = 16) vs No (n = 39)	31.3 vs 53.8	0.127	25.0 vs 38.5	0.340
Cytomegalovirus infection
Yes (n = 17) vs No (n = 38)	47.1 vs 47.4	0.999	47.1 vs 28.9	0.192
Acute cellular rejection
Yes (n = 23) vs No (n = 32)	60.9 vs 37.5	0.087	47.8 vs 25.0	0.079
Total bilirubin at PLB
≥ 0.7 mg/dL (n = 25) vs < 0.7 mg/dL (n = 30)	48.0 vs 46.7	0.920	36.0 vs 33.3	0.836
AST at PLB
≥ 30 IU/L (n = 22) vs < 30 IU/L (n = 33)	54.5 vs 42.4	0.378	36.4 vs 33.3	0.816
ALT at PLB
≥ 20 IU/L (n = 21) vs < 20 IU/L (n = 34)	57.1 vs 41.2	0.249	28.6 vs 38.2	0.464
γ-GTP at PLB
≥ 20 IU/L (n = 20) vs < 20 IU/L (n = 35)	45.0 vs 48.6	0.799	30.0 vs 37.1	0.592
Hyaluronic acid at PLB
≥ 20 ng/mL (n = 22) vs < 20 ng/mL (n = 33)	50.0 vs 45.5	0.741	36.4 vs 33.3	0.816
IgG at PLB
≥ 1200 mg/dL (n = 24) vs < 1200 mg/dL (n = 31)	54.2 vs 41.9	0.368	41.7 vs 29.0	0.328
ANA at PLB
≥ 20 × (n = 14) vs < 20 × (n = 41)	35.7 vs 51.2	0.316	28.6 vs 36.6	0.586
ASMA at PLB
≥ 20 × (n = 10) vs < 20 × (n = 45)	70.0 vs 42.2	0.111	40.0 vs 33.3	0.688
Trough of tacrolimus at PLB
≥ 3.0 ng/mL (n = 19) vs < 3.0 ng/mL (n = 33)1	52.6 vs 42.4	0.477	36.8 vs 33.3	0.797

¹Three cases which were used a cyclosporine were removed. LDLT: Living donor liver transplantation; PELD: Pediatric end-stage liver disease; MELD: Model for end-stage liver disease; GV/SLV: Ratio of graft volume to standard liver volume; PLB: Protocol liver biopsy; AST: Aspartate amino transferase; ALT: Alanine amino transferase; IgG: Immunoglobulin G; ANA: Antinuclear antibody; ASMA: Antismooth nuclear antibody.

Table 6 Clinical and histopathological findings of cases who performed protocol liver biopsy at both two and five years after living donor liver transplantation

Case	Original disease	Age at LT/sex	Previous ACR	Post-transplant complications	IS at two years PLB	Tac trough at PLB	ALT/HA at PLB	A/F at PLB	IS at five years PLB	Tac trough at PLB	ALT/HA at PLB	A/F at PLB
1	OTCD	46/female	-	-	Tac (3.0)	2.5	12/35	2/1	Tac (1.0)/MMF (400)	0.5	11/52	1/1
11	BA	26/male	+	PVS	Tac (0.8)/MP (4.0)/MMF (500)	3.2	20/11	0/1	Tac (1.6)/MP (4.0)/MMF (1500)	2.2	12/17	2/2
12	BA	114/male	-	BDS	Tac (2.0)	2.6	14/21	1/0	Tac (3.0)	2.3	16/20	1/2
13	BA	10/female	+	CMV-I	Tac (0.4)	3.8	19/11	0/0	Tac (1.6)	2.8	18/< 9	1/2
14	BA	30/male	-	HVS	Tac (1.2)	5.3	18/29	1/1	Tac (2.0)/MP (1.0)/MMF (1000)	5.6	12/23	1/2
15	BA	120/female	-	BDS	Tac (1.5)/PSL (2.5)	4.4	15/14	0/0	Tac (4.0)	7.0	17/< 9	0/0
16	BA	163/male M	+	BDS/CMV-I	CsA (150)	CsA 50	9/27	0/0	CsA (150)/MMF (1000)	CsA 83	91020	0/1
17	BA	8/female	+/OKT3	PVS/CMV-I	Tac (0.8)/MP (0.5)	2.4	30/36	0/0	Tac (2.0)	5.3	15/18	1/1
18	BA	12/male	+	-	Tac (0.8)	3.8	14/58	0/0	Tac (0.8)	0.2	8/20	1/1
19	BA	13/female	+	CMV-I	Tac (1.6)/MP (2.0)	9.3	22/11	0/0	Tac (1.4)/MP (3.0)/MMF (500)	2.1	15/15	0/1
20	AD	19/female	+	CMV-I	Tac (0.8)/MMF (500)	2.3	19/13	0/1	Tac (2.4)/MMF (500)	3.8	14/15	1/1
21	WD	112/male	-	-	Tac (4.0)	1.3	16/16	0/0	Tac (5.0)	1.4	19/13	0/0
22	BA	170/female	+	BDS	Tac (2.0)	6.3	17/16	0/1	Tac (6.0)/MP (12)/MMF (2000)	15.5	39/22	1/0
23	BA	33/F	+	HVS	Tac (1.0)/MP (2.0)/MMF (400)	3.7	10/< 9	0/0	Tac (1.5)/MMF (1000)	5.4	41/19	1/0
24	BA	9/female	-	HAT	Tac (0.6)	0.3	14/24	0/0	Tac (0.8)	0	10/10	0/0
25	BA	28/female	-	-	Tac (0.4)	2.8	18/< 9	0/0	Tac (1.0)	0.9	15/10	1/0
26	BA	9/female	-	IHBDS	Tac (0.4)	2.1	23/< 9	0/1	Tac (2.0)/MP (0.5)/MMF (500)	5.3	41/19	1/1
27	AD	19/male	-	-	Tac (0.6)	3.3	12/17	0/0	Tac (2.0)/MMF (500)	1.5	11/59	0/0
28	BA	45/female	-	BDS	Tac (1.2)	3.6	13/15	0/0	Tac (1.5)	4.6	11/10	0/0
29	BA	9/female	-	-	Tac (0.4)	0.9	11/17	0/0	Tac (0.8)	1.1	13/25	0/0
30	CEPS	37/male	-	-	Tac (2.0)/MP (2.5)/MMF (500)	2.5	13/< 9	0/0	Tac (2.0)/MP (1.5)/MMF (500)	3.9	11/< 9	0/0

PLB: Protocol liver biopsy; LDLT: Living donor liver transplantation; ACR: Acute cellular rejection; IS: Immunosuppressants; Tac: Tacrolimus; ALT: Alanine amino transferase; HA: Hyaluronic acid; A: Activity; F: Fibrosis; OTCD: Ornithine transcarbamylase deficiency; BA: Biliary atresia; AD: Alagille syndrome; WD: Wilson disease; CEPS: Congenital extrahepatic portsystemic shunt; OKT3: Muromonab-CD3; PVS: Portal vein stenosis; BDS: Biliary duct anastomotic stenosis; CMV-I: Cytomegalovirus infection; HVS: Hepatic vein stenosis; HAT: Hepatic artery thrombosis; IHBDS: Intrahepatic biliary duct stenosis; MP: Methylprednisolone; MMF: Mycophenolate mofetil; PSL: Prednisolone; CsA: Cyclosporin A.