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Living Related Liver Transplantation for Biliary Atresia in the Last 5 years: Experience from the First Liver Transplant Program in India

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Abstract

Objective

To study the clinical, biochemical profile and outcome of patients with biliary atresia (BA) who underwent living related liver transplantation (LRLT) at authors’ institute in the last 5 y (2008–2013).

Methods

Case records of the 20 patients diagnosed with biliary atresia who had undergone living related liver transplantation at authors’ centre in the last 5 y were analysed.

Results

Eighteen patients with BA with a failed Kasai procedure and 2 without a prior Kasai's portoenterostomy received a liver transplant. At a median follow up of 2 y and 6 mo, both the patient and graft survival rates were 90 %. The median age of the recipients at the time of LRLT was 8 mo and 12 (60 %) of the transplanted children were less than or equal to 1 y of age. The male–female ratio was 1.8:1. The median weight was 7.3 kg (5.8–48 kg); two thirds were less than 10 kg. The median pre-transplant total serum bilirubin (TSB) and international normalized ratio (INR) were 12.98 (0.5–48.3) mg/dl and 1.3 (1.0–3.9) respectively. All patients received a living related graft and there was no donor mortality. The median duration of postoperative ventilation was 14 h. The post-operative complications were infection (30 %), vascular complications (20 %) and acute rejection (20 %). The median duration of postoperative hospital stay was 21 d (17–42). Two patients died of combined hepatic and portal vein thrombosis in the early postoperative period. Late rejection was encountered in 1 patient and another developed chronic kidney disease necessitating a renal transplant. There were no late vascular occlusions or development of post transplant lymphoproliferative disease.

Conclusions

Thus, LRLT for BA with or without a prior portoenterostomy, is a feasible and successful treatment modality with good outcomes attained despite the challenges of age and size. This treatment modality is now well established in India.

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Contributions

SM: Wrote first manuscript, patient care, data collection; AS, VB, AK, SG: Patient care, edited the manuscript; SS, SG, NJ, MW: Patient care. AS will act as guarantor for this paper.

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Authors and Affiliations

  1. Apollo Centre for Advanced Pediatrics, Indraprastha Apollo Hospital, New Delhi, 110076, India

    Smita Malhotra, Anupam Sibal, Vidyut Bhatia, Akshay Kapoor, Sarath Gopalan, Swati Seth & Nameet Jerath

  2. Centre for Liver and Biliary Sciences, Indraprastha Apollo Hospital, New Delhi, India

    Manav Wadhawan & Subash Gupta

Authors
  1. Smita Malhotra
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  2. Anupam Sibal
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  4. Akshay Kapoor
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  6. Swati Seth
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  9. Subash Gupta
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Correspondence to Anupam Sibal.

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Malhotra, S., Sibal, A., Bhatia, V. et al. Living Related Liver Transplantation for Biliary Atresia in the Last 5 years: Experience from the First Liver Transplant Program in India. Indian J Pediatr 82, 884–889 (2015). https://doi.org/10.1007/s12098-014-1687-x

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  • DOI: https://doi.org/10.1007/s12098-014-1687-x

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