Liver Transplantation for Biliary Atresia H. Karakayali, S. Sevmis, U ¨ . Özçelik, F. Ozcay, G. Moray, A. Torgay, G. Arslan, and M. Haberal ABSTRACT Biliary atresia is the most common indication for liver transplantation (OLT) in children. We present our experience with OLT as a treatment for end-stage liver disease in children with biliary atresia. We performed a retrospective review of 20 biliary atresia patients (11 male, 9 female patients; mean age, 21.4 months; range, 6 to 84 months) who had undergone OLT. Mean preoperative weight and height were 10.1  5.8 kg and 72.5 cm, respectively. Thirteen recipients were younger than 1 year of age, and 15 weighed less than 10 kg at the time of OLT. Fourteen recipients had undergone a Kasai operation prior to the OLT. The mean serum total bilirubin level was 22.56 mg/dL before OLT. Eighteen left lateral segment grafts and two whole grafts were transplanted. The mean recipient operative time was 9.25 hours. The mean recipient intraoperative blood loss was 1.81 U. Two hepatic arterial thromboses and one biliary leak occurred soon after surgery. Portal vein stenoses developed in two recipients at 10 and 12 months after OLT; both were treated with balloon dilatation. Two biliary stenoses, which occurred at 10 months and 3.5 years after surgery, were treated with balloon dilatation. Two recipients died at 2 and 12 days after OLT because of respiratory distress syndrome and sepsis, respectively. The remaining 18 (90%) recipients are alive with good graft function. The overall rejection rate was 31.25%. OLT is an effective treatment for children with biliary atresia and a failed Kasai procedure. Living related liver grafts represented an excellent organ supply for these patients. B ILIARY ATRESIA is a rare disease characterized by biliary obstruction of unknown origin, which presents during the neonatal period. It is the most frequent cause for surgery in patients presenting with cholestatic jaun- dice in this age group. The reported worldwide incidence of biliary atresia varies from 5/100,000 to 32/100,000 live births; it is highest in Asia and in the Pacific region. Girls are affected slightly more often than boys. If untreated, biliary atresia leads to cirrhosis and death within the first years of life. Once biliary atresia is detected, surgical intervention (a Kasai portoenterostomy) should be per- formed as soon as possible. Operations performed earlier are more likely to be successful. Liver transplantation (OLT) may be needed later if the Kasai operation fails to restore biliary flow or if cirrhotic complications occur. 1 The first attempted use of OLT to treat biliary atresia was made in 1963. 2 Since then, biliary atresia has become the most common indication for OLT among pediatric recipients. In this study, we have described current patient and graft survival rates and causes of death for pediatric patients with biliary atresia undergoing OLT at our center. In addition, we examined causes of morbidity and mortality following OLT for biliary atresia. MATERIALS AND METHODS We retrospectively reviewed our experience in pediatric liver transplant for biliary atresia. Between December 2002 and July 2008, 180 OLTs were performed in 177 recipients including 83 children, 20 (24%) of whom had biliary atresia. We transplanted 18 left lateral segment grafts and two whole grafts. Most donors were a parent of the recipient (80%) with the mean age of the living donor being 29.66  8.4 years (range, 23 to 35 years). The two deceased donors were aged 1 and 7 years. For biliary drainage, a feeding tube was used in four recipients, and a transhepatic catheter in eight. In the remaining nine recipients, no tube or stent was used. Four of the 20 liver grafts had two bile ducts, and 16 had From the Departments of General Surgery (H.K., S.S., U ¨ .Ö., G.M., M.H.), Gastroentology (F.O.), and Anesthesiology (A.T., G.A.), Bas ¸ kent University Faculty of Medicine, Ankara, Turkey. Address reprint requests to Mehmet Haberal, MD, FACS, FICS (Hon), Bas ¸ kent University Faculty of Medicine, 1. Cad. No: 77 Kat: 4 Bahcelievler, 06490, Ankara, Turkey. E-mail: rektorluk@ baskent-ank.edu.tr © 2008 by Elsevier Inc. All rights reserved. 0041-1345/08/$–see front matter 360 Park Avenue South, New York, NY 10010-1710 doi:10.1016/j.transproceed.2007.11.015 Transplantation Proceedings, 40, 231–233 (2008) 231