Affiliation:
1. Division of Digestive and Liver Diseases UT Southwestern Medical Center Dallas Texas USA
2. Department of Surgery UT Southwestern Medical Center Dallas Texas USA
3. Department of Surgery University of Chicago Medicine Transplant Institute Chicago Illinois USA
4. Section of Gastroenterology and Hepatology, Department of Medicine Baylor College of Medicine Houston Texas USA
Abstract
AbstractBackgroundBiliary atresia (BA) remains the number one indication for paediatric liver transplantation (LT) worldwide but is an uncommon indication for older LT recipients. The impact of recent donor allocation changes, pervasive organ shortage and evolving LT practices on the BA LT population is unknown.MethodsWe identified patients who underwent LT between January 2010 and December 2021 using the UNOS database. We compared clinical outcomes between patients with BA and those with non‐BA cholestatic liver disease. Groups were stratified by age, <12 years (allocated via PELD system) and ≥12 years (allocated via MELD system). Waitlist outcomes were compared using competing‐risk regression analysis, graft survival rates were compared using Kaplan–Meier time‐to‐event analysis and Cox proportional hazards modelling provided adjusted estimates.ResultsThere were 2754 BA LT waitlist additions and 2206 BA LTs (1937 <12 years [younger], 269 ≥12 years [older]). There were no differences in waitlist mortality between BA and non‐BA cholestatic patients. Among BA LT recipients, there were 441 (20.0%) living‐donor liver transplantations (LDLT) and 611 (27.7%) split deceased‐donor LTs. Five‐year graft survival was significantly higher among BA versus non‐BA cholestatic patients in the older group (88.3% vs. 79.5%, p < .01) but not younger group (89.3% vs. 89.5%). Among BA LT recipients, improved graft outcomes were associated with LDLT (vs. split LT: HR: 2, 95% CI: 1.03–3.91) and higher transplant volume (volume >100 vs. <40 BA LTs: HR: 3.41, 95% CI: 1.87–6.2).ConclusionLiver transplant outcomes among BA patients are excellent, with LDLT and higher transplant centre volume associated with optimal graft outcomes.
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