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Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia
Introduction: Primary liver transplants (pLT) in patients with biliary atresia (BA) are infrequent, since most babies with BA undergo a prior Kasai portoenterostomy (KPE). This study compared transplant outcomes in children with BA with or without a prior KPE. We hypothesized that pLT have less morb...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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MDPI
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181323/ https://www.ncbi.nlm.nih.gov/pubmed/35683401 http://dx.doi.org/10.3390/jcm11113012 |
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author | Lemoine, Caroline P. LeShock, John P. Brandt, Katherine A. Superina, Riccardo |
author_facet | Lemoine, Caroline P. LeShock, John P. Brandt, Katherine A. Superina, Riccardo |
author_sort | Lemoine, Caroline P. |
collection | PubMed |
description | Introduction: Primary liver transplants (pLT) in patients with biliary atresia (BA) are infrequent, since most babies with BA undergo a prior Kasai portoenterostomy (KPE). This study compared transplant outcomes in children with BA with or without a prior KPE. We hypothesized that pLT have less morbidity and better outcomes compared to those done after a failed KPE. Methods: A retrospective review of patients with BA transplanted at our institution was performed. Patients were included if they received a pLT or if they were transplanted less than 2 years from KPE. Outcomes were compared between those groups. Comparisons were also made based on era (early: 1997–2008 vs. modern: 2009–2020). p < 0.05 was considered significant. Results: Patients who received a pLT were older at diagnosis (141.5 ± 46.0 vs. KPE 67.1 ± 25.5 days, p < 0.001). The time between diagnosis and listing for transplant was shorter in the pLT group (44.5 ± 44.7 vs. KPE 140.8 ± 102.8 days, p < 0.001). In the modern era, the calculated PELD score for the pLT was significantly higher (23 ± 8 vs. KPE 16 ± 8, p = 0.022). Two waitlist deaths occurred in the KPE group (none in pLT, p = 0.14). Both the duration of transplant surgery and transfusion requirements were similar in both groups. There was a significant improvement in graft survival in transplants after KPE between eras (early era 84.3% vs. modern era 97.8%, p = 0.025). The 1-year patient and graft survival after pLT was 100%. Conclusions: Patient and graft survival after pLT are comparable to transplants after a failed KPE but pLT avoids a prior intervention. There was no significant difference in pre- or peri-transplant morbidity between groups other than wait list mortality. A multicenter collaboration with more patients may help demonstrate the potential benefits of pLT in patients predicted to have early failure of KPE. |
format | Online Article Text |
id | pubmed-9181323 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-91813232022-06-10 Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia Lemoine, Caroline P. LeShock, John P. Brandt, Katherine A. Superina, Riccardo J Clin Med Article Introduction: Primary liver transplants (pLT) in patients with biliary atresia (BA) are infrequent, since most babies with BA undergo a prior Kasai portoenterostomy (KPE). This study compared transplant outcomes in children with BA with or without a prior KPE. We hypothesized that pLT have less morbidity and better outcomes compared to those done after a failed KPE. Methods: A retrospective review of patients with BA transplanted at our institution was performed. Patients were included if they received a pLT or if they were transplanted less than 2 years from KPE. Outcomes were compared between those groups. Comparisons were also made based on era (early: 1997–2008 vs. modern: 2009–2020). p < 0.05 was considered significant. Results: Patients who received a pLT were older at diagnosis (141.5 ± 46.0 vs. KPE 67.1 ± 25.5 days, p < 0.001). The time between diagnosis and listing for transplant was shorter in the pLT group (44.5 ± 44.7 vs. KPE 140.8 ± 102.8 days, p < 0.001). In the modern era, the calculated PELD score for the pLT was significantly higher (23 ± 8 vs. KPE 16 ± 8, p = 0.022). Two waitlist deaths occurred in the KPE group (none in pLT, p = 0.14). Both the duration of transplant surgery and transfusion requirements were similar in both groups. There was a significant improvement in graft survival in transplants after KPE between eras (early era 84.3% vs. modern era 97.8%, p = 0.025). The 1-year patient and graft survival after pLT was 100%. Conclusions: Patient and graft survival after pLT are comparable to transplants after a failed KPE but pLT avoids a prior intervention. There was no significant difference in pre- or peri-transplant morbidity between groups other than wait list mortality. A multicenter collaboration with more patients may help demonstrate the potential benefits of pLT in patients predicted to have early failure of KPE. MDPI 2022-05-26 /pmc/articles/PMC9181323/ /pubmed/35683401 http://dx.doi.org/10.3390/jcm11113012 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Lemoine, Caroline P. LeShock, John P. Brandt, Katherine A. Superina, Riccardo Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia |
title | Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia |
title_full | Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia |
title_fullStr | Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia |
title_full_unstemmed | Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia |
title_short | Primary Liver Transplantation vs. Transplant after Kasai Portoenterostomy for Infants with Biliary Atresia |
title_sort | primary liver transplantation vs. transplant after kasai portoenterostomy for infants with biliary atresia |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9181323/ https://www.ncbi.nlm.nih.gov/pubmed/35683401 http://dx.doi.org/10.3390/jcm11113012 |
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