Liver transplantation for biliary atresia: A single-center study from mainland China

Table 1 Characteristics of children with biliary atresia in stages I and II (n = 188) n (%)

Variable	Stage I (n = 74)	Stage II (n = 114)	P-value
Gender			0.146
Boys	45 (60.8)	57 (50.0)
Girls	29 (39.2)	57 (50.0)
Age			0.315
≤ 12 mo	53 (71.6)	89 (78.1)
> 12 mo	21 (28.4)	25 (21.9)
Place of birth			0.698
Rural	44 (59.5)	71 (62.3)
Urban	30 (40.5)	43 (37.7)
Hospital class for initial treatments			0.072
I or II	49 (66.2)	89 (78.1)
III	25 (33.8)	25 (21.9)
Previous surgical intervention
None	28 (37.9)	39 (34.2)	0.612
Laparotomy	22 (29.7)	24 (21.1)	0.176
KP	24 (32.4)	51 (44.7)	0.092
Referral for transplantation			< 0.001
Referred	32 (43.2)	81 (71.1)
Non-referred	42 (56.8)	33 (28.9)
Reason for no transplantation
Refusal by the parents	20 (27.0)	16 (14.0)	0.027
Lack of a suitable graft	9 (12.2)	21 (18.4)	0.252

KP: Kasai procedure.

Table 2 Baseline characteristics of liver transplantation recipients with biliary atresia (n = 122)

Variable	Living-donor (n = 102)	Split (n = 19)	Whole liver(n = 1)
Gender
Boys	57 (55.9)	7 (36.8)	1
Girls	45 (44.1)	12 (63.2)	0
Age (mo)	9.3 (4.5-70.1)	10.5 (5.6-118.4)	7.8
Body weight (kg)	8.0 (5-19)	8.0 (6-28)	10.0
Height (cm)	67 (56-108)	67 (62-115)	70
PELD score	17 (-9-36)	16 (-7-36)	21
Surgical history
KP	42 (41.2)	6 (31.6)	0
Laparotomy	29 (28.4)	6 (31.6)	0
ABO blood group
A	34 (33.3)	4 (21.1)	0
B	27 (26.5)	4 (21.1)	0
AB	11 (10.8)	5 (26.3)	1
O	30 (29.4)	6 (31.5)	0
Graft type
Whole liver	0	0	1
LLS	99	17	0
Left lobe without MHV	2	1	0
Left lobe with MHV	1	0	0
Extended right lobe	0	1	0
GRWR (%)	2.7 (1.5-5.4)	2.7 (1.1-4.2)	4.0

The values are expressed as numbers (%) or medians (range). GRWR: Graft-to-recipient body weight ratio; KP: Kasai procedure; LLS: Left lateral segment; MHV: Middle hepatic vein; PELD: Pediatric end-stage liver disease.

Table 3 Characteristics of living donors (n = 102)

Variable
Age (yr)	30 (20-56)
Gender
Male	43 (42.2)
Female	59 (57.8)
BMI (kg/m2)	21.4 (16.9-27.5)
D/R ABO compatibility
Identical	78 (76.5)
Compatible	24 (23.5)
D/R relationship
Parent	94 (92.1)
Grandparent	6 (5.9)
Uncle/Aunt	2 (2.0)
Graft weight (g)	247.5 (145-420)
Postoperative hospital stay (d)	7 (4-19)
Postoperative complications
Wound infection (grade I)	2
Pulmonary infection (grade II)	2

The values are expressed as numbers (%) or medians (range). BMI: Body mass index; D/R: Donor/recipient.

Table 4 Postoperative complications after liver transplantation

Complications	Patient number1		Managements	Outcomes2
	Stage I (n = 45)	Stage II (n = 77)
Surgical complications
HAT	4	2	DSA (3 pts); thrombectomy and reconstruction (6 pts)	3 pts died
PVT	5	5	Reoperation (5 pts); metal stent placement (1 pt)	7 pts died
Biliary leakage	3	2	Drainage or reoperation	3 pts died
Biliary stricture	2	1	PTCD (1 pt)	2 pts died
Biliary sludge	1	0	Retransplantation	Alive
Wound dehiscence	3	1	Debridement and re-closure	2 pts died
Digestive tract perforation	2	2	Reoperation	4 pts died
Intra-abdominal bleeding	0	1	Reoperation	Alive
Wound infection	1	0	Regular wound dressing	1 pt died
Small-for-size syndrome	0	1	-	1 pt died
Large-for-size syndrome	0	1	-	1 pt died
Non-surgical complications
Pulmonary infection	14	16	Antibiotics (30 pts); mechanical ventilation (5 pts)	11 pts died
CMV infection	17	13	Antivirus therapy	7 pts died
EBV infection	3	10	Antivirus therapy	1 pt died
De novo HBV infection	7	6	Antivirus therapy	2 pts died
Drug-induced liver injury	0	1	Withdrawal of the drug	1 pt died
Tuberculous pleurisy	1	0	Anti-tuberculosis	Alive
Acute rejection	15	13	Increased the dosage of the immunosuppressant; bolus doses of steroids	5 pts died
PTLD	0	1	-	1 pt died
Hirsutism	7	0	Replacement of cyclosporine with tacrolimus	1 pt died
Intravascular hemolysis	1	1	Steroid therapy; withdrawal of blood transfusion	1 pt died

¹Multiple complications might occur in a single patient;

²Patients who experienced the complication but died from other reasons before the last follow-up contact were also included. CMV: Cytomegalovirus; DSA: Digital subtraction angiography; EBV: Epstein-Barr virus; HAT: Hepatic artery thrombosis; HBV: Hepatitis B virus; pt: Patient; PTCD: Percutaneous transhepatic cholangial drainage; PTLD: Posttransplant lymphoproliferative disease; pts: Patients; PVT: Portal venous thrombosis.