Adults Undergoing First Time Liver Transplantation with Biliary Atresia: An Analysis of the United Network for Organ Sharing Database

E. Hsu¹, J. Perkins², S. P. Horslen¹, A. A. Dick¹, N. M. Blondet¹, J. D. Reyes²

¹Seattle Children's Hospital, Seattle, WA, ²Surgery, University of Washington School of Medicine, Seattle, WA

Meeting: 2021 American Transplant Congress

Abstract number: 1167

Keywords: Liver transplantation, Outcome, Pediatric, Waiting lists

Topic: Clinical Science » Liver » Liver: Pediatrics

Session Information

Session Name: Liver: Pediatrics

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Although biliary atresia (BA) is the most common indication for liver transplantation in children, there is no published data on outcomes for individuals who survive into adulthood with their native liver. In order to better counsel this subset of patients as they transition from pediatric to adult care, we utilized national transplant registries over a 16-year period to characterize waitlist and post-transplant outcomes.

*Methods: We conducted a retrospective analysis of all candidates on the United Network for Organ Sharing (UNOS) waitlist from February 2002 until September 2018 listed for first liver transplant with a primary diagnosis of BA, and with transplant occurring after the candidate’s 18^th birthday. We performed a 5:1 propensity matched analysis for recipients with other chronic liver diseases.

*Results: Over the 16-year range of the study, 283 individuals met criteria for inclusion for the analysis. 26 (9.2%) died on the wait list, and 158 (55.8%) were transplanted. The remainder were still listed at time of analysis or removed for no longer requiring transplant. Median age at end-event was 24.8 years. Individuals who died on the waitlist had higher MELD scores, fewer exceptions, and were overrepresented by Black and Hispanic race. The majority of candidates transplanted in adulthood for BA were in their 3^rd decade of life and waited for a transplant more than 3 years on average. 8% had a TIPS in place and more than 5% had a co-diagnosis of hepatocellular carcinoma. Post-transplant outcomes were comparable to individuals with BA transplanted in childhood and with adults on the waitlist with cholestatic liver disease.

*Conclusions: Patients surviving into adulthood with BA and their native liver may require transplantation beyond the 2^nd decade of life. The majority of these transplants are occurring at or after a transition of healthcare teams and healthcare coverage. Despite these challenges, post-transplant graft and survival outcomes are excellent.

To cite this abstract in AMA style:

Hsu E, Perkins J, Horslen SP, Dick AA, Blondet NM, Reyes JD. Adults Undergoing First Time Liver Transplantation with Biliary Atresia: An Analysis of the United Network for Organ Sharing Database [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/adults-undergoing-first-time-liver-transplantation-with-biliary-atresia-an-analysis-of-the-united-network-for-organ-sharing-database/. Accessed May 11, 2025.

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