Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

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 an...

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Autores principales:	Miriam Cortes-Cerisuelo, Christina Boumpoureka, Noel Cassar, Deepak Joshi, Marianne Samyn, Michael Heneghan, Krishna Menon, Andreas Prachalias, Parthi Srinivasan, Wayel Jassem, Hector Vilca-Melendez, Anil Dhawan, Nigel D. Heaton
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	extra-hepatic biliary atresia aneurysm shunts liver transplantation Medicine R
Acceso en línea:	https://doaj.org/article/12077cc92fbb4b1f91e00f67eaea0d2c
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spelling	oai:doaj.org-article:12077cc92fbb4b1f91e00f67eaea0d2c2021-11-11T17:36:07ZLiver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience10.3390/jcm102149692077-0383https://doaj.org/article/12077cc92fbb4b1f91e00f67eaea0d2c2021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4969https://doaj.org/toc/2077-0383Background: 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: 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: 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.Miriam Cortes-CerisueloChristina BoumpourekaNoel CassarDeepak JoshiMarianne SamynMichael HeneghanKrishna MenonAndreas PrachaliasParthi SrinivasanWayel JassemHector Vilca-MelendezAnil DhawanNigel D. HeatonMDPI AGarticleextra-hepatic biliary atresiaaneurysmshuntsliver transplantationMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4969, p 4969 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	extra-hepatic biliary atresia aneurysm shunts liver transplantation Medicine R
spellingShingle	extra-hepatic biliary atresia aneurysm shunts liver transplantation Medicine R Miriam Cortes-Cerisuelo Christina Boumpoureka Noel Cassar Deepak Joshi Marianne Samyn Michael Heneghan Krishna Menon Andreas Prachalias Parthi Srinivasan Wayel Jassem Hector Vilca-Melendez Anil Dhawan Nigel D. Heaton Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience
description	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: 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: 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.
format	article
author	Miriam Cortes-Cerisuelo Christina Boumpoureka Noel Cassar Deepak Joshi Marianne Samyn Michael Heneghan Krishna Menon Andreas Prachalias Parthi Srinivasan Wayel Jassem Hector Vilca-Melendez Anil Dhawan Nigel D. Heaton
author_facet	Miriam Cortes-Cerisuelo Christina Boumpoureka Noel Cassar Deepak Joshi Marianne Samyn Michael Heneghan Krishna Menon Andreas Prachalias Parthi Srinivasan Wayel Jassem Hector Vilca-Melendez Anil Dhawan Nigel D. Heaton
author_sort	Miriam Cortes-Cerisuelo
title	Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience
title_short	Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience
title_full	Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience
title_fullStr	Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience
title_full_unstemmed	Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience
title_sort	liver transplantation for biliary atresia in adulthood: single-centre surgical experience
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/12077cc92fbb4b1f91e00f67eaea0d2c
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Liver Transplantation for Biliary Atresia in Adulthood: Single-Centre Surgical Experience

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