The Influence Of Kasai Operation On Living Donor Liver Transplantation For Children With Biliary Atresia

Objective: To evaluate the influence of Kasai operation on living donor liver transplantation(LDLT) for children with biliary atresia.Methods:We retrospectively reviewed85children who underwent LDLT from Jul.2010to Oct.2013. Among these children,46(54.1%) underwent LDLT after Kasai operation,39(45.9%) underwent LDLT without prior Kasai opertation, respectively were divided into Kasai group and non-Kasai group. The differences of general data, postoperative complications and cumulative survival rate between the two groups were compared.Results:The median age of11.2months(6-82.5months) and the median preoperative bilirubin level of186.5umol/L(7.08-7.19umol/L) of the Kasai group are significant different from the median age of7.8months(5.8-43months) and the median preoperative bilirubin level of330.13umol/L(102-556.24umol/L) of the non-Kasai group(all in P＜0.01). The preoperative height(72.5±12.2)cm, weight(9.4±4.5)kg, median PELD score of15(-9-36) and intraoperative blood transfusion(718.7±315.1)mL of the Kasai group are different from the preoperative height(67.2±6.2)cm, weight(7.7±1.5)kg, median PELD score of17.5(0～38) and intraoperative blood transfusion(580.4±246.3)mL of the non-Kasai group. But no significant differences were observed in albumin, creatinine, INR, Chilid-Pugh score, graft weight, GRWR, warm ischemia time, cold ischemia time, anhepatic phase, hepatic artery anastomosis time, blood loss, operative time, ICU stay time and hospital stay time between the two groups (all in P>0.05). The incidence of CMV infection(10.9%) was highest in Kasai group, followed by pulmonary infection(8.7%). The incidence of EBV infection(15.4%) was highest in non-Kasai group, followed by CMV infection(12.8%). There were no significant differences in the incidence of perioperative complications and delayed complications between the two groups (all in P>0.05). The time of follow-up range0.2～39.8months with a median of7months. There were4patients died in85patients, including3patients in the Kasai group and1patient in the non-Kasai group. The main cause of death was the death of graft failure. No donor mortality was encountered. The overall1-month,1-and3-year cumulative survival rates for recipients were96.5%,95.3%and95.3%, respectively. The1-month,1-and3-year cumulative survival rates for the Kasai group were95.7%,93.5%and93.5%, respectively. The1-month,1-and3-year cumulative survival rates for the non-Kasai group were97.4%,97.4%and97.4%, respectively. No significant differences were observed between the two groups (P=0.397).Conclusion: Kasai operation, as the first step of sequential treatment for biliary atresia, did not increase the incidence of complications and mortality after transplantation. In contrast, the success of Kasai operation can postpone transplantation. The later in life the transplantation must be performed, the lower the incidence of complications and mortality.