While poor bile drainage after a Kasai hepatoportoenterostomy (KPE) is the primary driver for liver transplantation (LT) for Biliary Atresia (BA) in infancy, the data on the indications and the outcomes of LT performed during adolescence are largely unknown. Objectives: To compare the clinical characteristics and outcome of first isolated LT (FILT) for adolescents with BA who were transplanted between age 10-18 age (A-LT) with children transplanted earlier in life (age <10, E-LT), in the PELD/MELD era. Methods: Children with BA who underwent LT between 2002 and 2014 were identified from the UNOS Standard Transplant Analysis and Research (STAR) dataset files. Results: 2055 children underwent FILT for BA [A-LT, 148 (7.2%); E-LT, 1907 (92.7%)]. Characteristics of the sample are shown in Table 1.

One and five year patient survival of the A-LT and E-LT patients was 98.6 %, 95.9 % and 95.6%, 94.4%, respectively (P>0.05 for both periods). One year graft survival of the A-LT and E-LT patients was 95.9%, 88.7% respectively, P<0.01.Primary non function (PNF), (2.7)%, and chronic rejection, (2%) were the main causes for graft loss in the A-LT group and vascular thrombosis, (5.7%) and PNF, (3.9%) in the E-LT group. Conclusions: Adolescents with BA have better synthetic function and less cholestasis at LT with significantly higher one year graft survival compared to younger children with BA. The better outcomes of LT in adolescents highlight the need for continued diagnostic and surgical efforts to improve bile drainage after KPE which may postpone transplant until adolescence.

CITATION INFORMATION: Chu J, Annunziato R, Reinoso D, Ramaswami A, Arnon R. Liver Transplantation for Adolescents with Biliary Atresia in the PELD/MELD Era: An Analysis of the UNOS Database. Am J Transplant. 2017;17 (suppl 3).

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