Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience.
aneurysm
extra-hepatic biliary atresia
liver transplantation
shunts
Journal
Journal of clinical medicine
ISSN: 2077-0383
Titre abrégé: J Clin Med
Pays: Switzerland
ID NLM: 101606588
Informations de publication
Date de publication:
26 Oct 2021
26 Oct 2021
Historique:
received:
09
10
2021
revised:
21
10
2021
accepted:
22
10
2021
entrez:
13
11
2021
pubmed:
14
11
2021
medline:
14
11
2021
Statut:
epublish
Résumé
Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood. Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms. Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS was present in 72.7% of the patients. Graft and patient survival at 1, 5, and 10 years was 97.1%, 91.2%, 91.2% and 100%, 94%, 94%, respectively Conclusions: Good outcomes after LT for BA in young patients can be achieved with careful donor selection and surgery to minimise the risk of complications. Identification of anatomical variants and shunting are helpful in guiding attitude at the time of transplant.
Sections du résumé
BACKGROUND
BACKGROUND
Biliary atresia (BA) is the most common indicator for liver transplant (LT) in children, however, approximately 22% will reach adulthood with their native liver, and of these, half will require transplantation later in life. The aim of this study was to analyse the surgical challenges and outcomes of patients with BA undergoing LT in adulthood.
METHODS
METHODS
Patients with BA requiring LT at the age of 16 or older in our unit between 1989 and 2020 were included. Pretransplant, perioperative variables and outcomes were analysed. Pretransplant imaging was reviewed to assess liver appearance, spontaneous visceral portosystemic shunting (SPSS), splenomegaly, splenic artery (SA) size, and aneurysms.
RESULTS
RESULTS
Thirty-four patients who underwent LT for BA fulfilled the inclusion criteria, at a median age of 24 years. The main indicators for LT were synthetic failure and recurrent cholangitis. In total, 57.6% had significant enlargement of the SA, 21% had multiple SA aneurysm, and SPSS was present in 72.7% of the patients. Graft and patient survival at 1, 5, and 10 years was 97.1%, 91.2%, 91.2% and 100%, 94%, 94%, respectively Conclusions: Good outcomes after LT for BA in young patients can be achieved with careful donor selection and surgery to minimise the risk of complications. Identification of anatomical variants and shunting are helpful in guiding attitude at the time of transplant.
Identifiants
pubmed: 34768489
pii: jcm10214969
doi: 10.3390/jcm10214969
pmc: PMC8584637
pii:
doi:
Types de publication
Journal Article
Langues
eng
Références
Pediatr Surg Int. 2017 Feb;33(2):155-163
pubmed: 27882406
Transpl Int. 1991 Jun;4(2):122-4
pubmed: 1910429
Surg Gynecol Obstet. 1985 Jul;161(1):66-8
pubmed: 3892734
J Pediatr Gastroenterol Nutr. 2003 Jul;37(1):4-21
pubmed: 12827000
Hepatology. 2005 Feb;41(2):366-71
pubmed: 15660386
Liver Transpl. 2004 Sep;10(9):1183-8
pubmed: 15350012
Transplantation. 2009 Mar 15;87(5):734-9
pubmed: 19295319
Transplantation. 1989 Sep;48(3):530-1
pubmed: 2675416
Int J Surg. 2014 Nov;12(11):1228-34
pubmed: 25311773
J Hepatol. 2019 Jul;71(1):71-77
pubmed: 30876944
J Pediatr Surg. 2015 Aug;50(8):1310-5
pubmed: 25917622
Pediatr Surg Int. 2017 Dec;33(12):1297-1304
pubmed: 29030698
J Pediatr Surg. 2012 Dec;47(12):2179-83
pubmed: 23217872
Liver Transpl. 2010 Aug;16(8):943-9
pubmed: 20677285
J Pediatr Surg. 2012 Mar;47(3):523-7
pubmed: 22424348
Transplant Proc. 2010 Oct;42(8):3169-70
pubmed: 20970639
Am J Transplant. 2006 Oct;6(10):2443-8
pubmed: 16889600
Transplantation. 2011 Aug 27;92(4):469-76
pubmed: 21775931
J Pediatr Surg. 1986 Jan;21(1):10-4
pubmed: 3944749
Liver Transpl. 2015 Jul;21(7):922-7
pubmed: 25832004
J Hepatol. 2017 Mar;66(3):631-644
pubmed: 27914924
Transplantation. 2019 Apr;103(4):e99-e107
pubmed: 30461724
J Pediatr Gastroenterol Nutr. 2006 Feb;42(2):190-5
pubmed: 16456414
Transplantation. 1988 Feb;45(2):386-9
pubmed: 3278432
Transpl Int. 2020 Dec;33(12):1807-1820
pubmed: 33166011
Neth J Med. 2013 May;71(4):170-3
pubmed: 23723110
Ann Surg. 2011 Dec;254(6):1008-16
pubmed: 21869678
Transplant Proc. 1971 Mar;3(1):308-12
pubmed: 4328809
World J Surg. 2020 Oct;44(10):3486-3490
pubmed: 32566975
Transplantation. 2017 Jul;101(7):1616-1627
pubmed: 28230640
J Gastroenterol. 2009;44(1):76-83
pubmed: 19159076
Arch Dis Child Fetal Neonatal Ed. 2009 Nov;94(6):F451-5
pubmed: 19457876
Br J Surg. 1973 Aug;60(8):646-9
pubmed: 4541913
Transpl Int. 1998;11(4):301-4
pubmed: 9704396
Ann Surg. 1990 Sep;212(3):368-75; discussion 375-7
pubmed: 2396888
Liver Transpl. 2018 Apr;24(4):505-515
pubmed: 29266668
J Hepatol. 1997 Nov;27(5):890-3
pubmed: 9382977
Transplantation. 2003 May 27;75(10):1692-7
pubmed: 12777858
J Pediatr Surg. 1997 Feb;32(2):168-72; discussion 172-4
pubmed: 9044116
Liver Transpl. 2009 Nov;15(11):1535-41
pubmed: 19877249
J Pediatr. 1987 Dec;111(6 Pt 2):1039-45
pubmed: 3316578
World J Gastroenterol. 2017 Mar 14;23(10):1735-1746
pubmed: 28348478
Eur J Pediatr Surg. 2007 Jun;17(3):180-3
pubmed: 17638156
Transplant Proc. 2015 Nov;47(9):2643-4
pubmed: 26680059
Gut. 2008 Feb;57(2):252-7
pubmed: 17895356
J Hepatol. 2021 Feb;74(2):372-379
pubmed: 32827564
Gastroenterology. 2003 Jan;124(1):91-6
pubmed: 12512033
J Pediatr Surg. 2019 Aug;54(8):1527-1538
pubmed: 30665627
Pediatr Transplant. 2015 Sep;19(6):E142-5
pubmed: 26121997