Utz Melere M, Sanha V, Farina M, da Silva CS, Nader L, Trein C, Lucchese AM, Ferreira C, Kalil AN, Feier FH. Primary liver transplantation vs transplant after Kasai portoenterostomy in children with biliary atresia: A retrospective Brazilian single-center cohort. World J Transplant 2024; 14(1): 88734 [PMID: 38576759 DOI: 10.5500/wjt.v14.i1.88734]
Corresponding Author of This Article
Flavia Heinz Feier, PhD, Professor, Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Rua Prof Annes Dias, Porto Alegre 90020-090, Brazil. flavia.feier@gmail.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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/
World J Transplant. Mar 18, 2024; 14(1): 88734 Published online Mar 18, 2024. doi: 10.5500/wjt.v14.i1.88734
Primary liver transplantation vs transplant after Kasai portoenterostomy in children with biliary atresia: A retrospective Brazilian single-center cohort
Melina Utz Melere, Valberto Sanha, Marco Farina, Carolina Soares da Silva, Luiza Nader, Cristine Trein, Angelica Maria Lucchese, Cristina Ferreira, Antonio Nocchi Kalil, Flavia Heinz Feier
Melina Utz Melere, Valberto Sanha, Marco Farina, Carolina Soares da Silva, Luiza Nader, Cristine Trein, Cristina Ferreira, Department of Hepatology and Liver Transplantation, Santa Casa de Porto Alegre, Porto Alegre 90050170, Brazil
Angelica Maria Lucchese, Flavia Heinz Feier, Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90020-090, Brazil
Antonio Nocchi Kalil, Department of Surgical Oncology, Santa Rita Hospital/Santa Casa de Misericórdia de Porto Alegre, Porto Alegre 90050-170, Rio Grande do Sul, Brazil
Author contributions: Sanha V, Melere M, and Feier FH designed the research study; Sanha V, Melere M, Farina M, and Feier FH wrote the manuscript; Nader L, Trein C, and Soares C collected and evaluated the data and wrote the manuscript; Ferreira C, Kalil NA, and Lucchese A wrote the manuscript and critically evaluated the final version; All authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Hospital Santa Casa de Porto Alegre Institutional Review Board.
Informed consent statement: All patients signed a general informed consent agreeing to the treatment and use of their anonymized clinical data. According to national and institutional regulations, special written consent is not needed for every particular study where anonymized clinical data are used.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at flavia.feier@gmail.com.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Flavia Heinz Feier, PhD, Professor, Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation, Irmandade Santa Casa de Misericórdia de Porto Alegre, Rua Prof Annes Dias, Porto Alegre 90020-090, Brazil. flavia.feier@gmail.com
Received: October 17, 2023 Peer-review started: October 17, 2023 First decision: November 2, 2023 Revised: November 14, 2023 Accepted: December 18, 2023 Article in press: December 18, 2023 Published online: March 18, 2024 Processing time: 149 Days and 18.7 Hours
Abstract
BACKGROUND
Biliary atresia (BA) is the most common indication for pediatric liver transplantation, although portoenterostomy is usually performed first. However, due to the high failure rate of portoenterostomy, liver transplantation has been advocated as the primary procedure for patients with BA. It is still unclear if a previous portoenterostomy has a negative impact on liver transplantation outcomes.
AIM
To investigate the effect of prior portoenterostomy in infants undergoing liver transplantation for BA.
METHODS
This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in Brazil. Patients with BA were divided into two groups: Those undergoing primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior portoenterostomy. Continuous variables were compared using the Student’s t-test or the Kruskal-Wallis test, and categorical variables were compared using the χ2 or Fisher’s exact test, as appropriate. Multivariable Cox regression analysis was performed to determine risk factors for portal vein thrombosis. Patient and graft survival analyses were conducted with the Kaplan–Meier product-limit estimator, and patient subgroups were compared using the two-sided log-rank test.
RESULTS
Forty-two patients were included in the study (25 [60%] girls), 23 undergoing liver transplantation without prior portoenterostomy, and 19 undergoing liver transplantation with prior portoenterostomy. Patients with prior portoenterostomy were older (12 vs 8 months; P = 0.02) at the time of liver transplantation and had lower Pediatric End-Stage Liver Disease scores (13.2 vs 21.4; P = 0.01). The majority of the patients (35/42, 83%) underwent living-donor liver transplantation. The group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis (39 vs 11%), but this result did not reach statistical significance. Prior portoenterostomy was not a protective factor against portal vein thrombosis in the multivariable analysis after adjusting for age at liver transplantation, graft-to-recipient weight ratio, and use of vascular grafts. Finally, the groups did not significantly differ in terms of post-transplant survival.
CONCLUSION
In our study, prior portoenterostomy did not significantly affect the outcomes of liver transplantation.
Core Tip: Children with biliary atresia comprise the majority of patients undergoing liver transplantation worldwide. Timely portoenterostomy can postpone or even remove the need for liver transplantation. Current data are not conclusive regarding whether performing a portoenterostomy negatively affects the transplantation procedure. In this study, we compared the outcomes of liver transplantation in patients with biliary atresia with or without prior portoenterostomy in a single center. Our results indicate that it does not affect the outcomes.
