Living Donor Liver Transplantation for Biliary Atresia: a Single-Center Experience with First 30 Cases

The aim of this study is to present our institutional experience in living donor liver transplantation (LDLT) as a treatment for end-stage liver disease in children with biliary atresia (BA). A retrospective study of pediatric patients who have undergone liver transplantation from January 2011 to December 2016 was performed. Thirty patients underwent liver transplant for biliary atresia out of 67 total pediatric transplants during this period. The records of these patients and their follow-up were retrospectively analyzed on recipient and donor demographic data, operative details, outcome, and complications. The mean follow-up period was 53.5 months. Eighteen recipients were males(60%). The mean age of recipients was 21 months. The mean preoperative weight and height were 11.2 kg and 72.5 cm, respectively. The mean PELD score was 17.57. Twenty-three (77%) had underwent previous Kasai procedure prior to transplant at mean age of 13 weeks. Twenty-two patients (73%) were nonbleeders. The mean operative time was 468 min. The mean intraoperative blood loss was 315 ml. Six did not require blood/blood component transfusion. The left lateral segment graft was used in 28 patients. The mean graft to recipient weight ratio was 2.08. Everyone received tacrolimus and prednisolone as immunosuppressants postoperatively as per protocol. There were 6 re-explorations which included 1 patient for bleeding, 1 for jejunal perforation, 1 for transverse colon perforation, 2 re-explored for hepatic artery thrombosis, and one retransplantation for primary nonfunction. There were 2 bile leaks which were managed conservatively. Two (6.6%) recipients died during their hospital stay. The overall rejection rate was 10%. The 3-year actual recipient survival rate was 90%. This improved survival is due to judicious preoperative donor and recipient selection, meticulous surgical technique, immediate detection and prompt intervention for complications, and keen postoperative surveillance.