The pre-Kasai procedure in living donor liver transplantation for children with biliary atresia

Hepatobiliary Pancreat Dis Int. 2013 Feb;12(1):47-53. doi: 10.1016/s1499-3872(13)60005-3.


Background: Biliary atresia (BA) is a major cause of chronic cholestasis, a fatal disorder in infants. This study was undertaken to evaluate the safety and effectiveness of primary living donor liver transplantation (LDLT) in comparison with the traditional first-line treatment, the Kasai procedure.

Methods: We assessed 28 children with BA at age of less than two years (3-21.3 months) who had undergone LDLT in two hospitals in Southwest China during the period of 2008-2011. Eighteen children who had had primary LDLT were included in a primary LDLT group, and ten children who had undergone the Kasai operation in a pre-Kasai group. All patients were followed up after discharge from the hospital. The records of the BA patients and donors were reviewed.

Results: The time of follow-up ranged 12-44.5 months with a median of 31 months. The 30-day and 1-year survival rates were 85.7% and 78.6%, respectively. There was no significant difference in the 30-day or 1-year survival between the two groups (83.3% vs 90% and 77.8% vs 80%, P>0.05). The main cause of death was hepatic artery thrombosis. There were more patients with complications who required intensive medical care or re-operation in the pre-Kasai group (8, 80%) than in the primary LDLT group (9, 50%) (P=0.226). But no significant differences were observed in operating time (9.3 vs 8.9 hours, P=0.77), intraoperative blood loss (208.6 vs 197.0 mL, P=0.84) and blood transfusion (105.6 vs 100.0 mL, P=0.91) between the two groups. The durations of ICU and hospital stay in the primary LDLT group and pre-Kasai group were 180.4 vs 157.7 hours (P=0.18) and 27 vs 29 days (P=0.29), respectively.

Conclusions: Primary LDLT is a safe and efficient management for young pediatric patients with BA. Compared with the outcome of LDLT for patients receiving a previous Kasai operation, a similar survival rate and a low rate of re-operation and intensive medical care for patients with BA can be obtained.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Biliary Atresia / mortality
  • Biliary Atresia / surgery*
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Humans
  • Infant
  • Intensive Care Units / statistics & numerical data
  • Kaplan-Meier Estimate
  • Length of Stay / statistics & numerical data
  • Liver Transplantation / methods*
  • Liver Transplantation / mortality
  • Living Donors*
  • Male
  • Portoenterostomy, Hepatic / methods*
  • Portoenterostomy, Hepatic / mortality
  • Postoperative Complications / mortality
  • Reoperation / statistics & numerical data
  • Thrombosis / mortality
  • Treatment Outcome