*Purpose: We evaluated 10 year outcomes and the potential predictors of outcomes after living donor liver transplant (LT) for biliary atresia (BA) patients with and without Kasai portoeneterostomy (KPE).

*Methods: We retrospectively reviewed pediatric BA patients underwent living donor liver transplantation (LDLT) at Memorial Hospital, Istanbul, Turkey between 2006-2016. Univariate analysis and Kaplan Meier survival analyses were performed.

*Results: Out of 87 cases, ten-year survival rate was 68%. Patients with KPE (n=59) were significantly older (6,95 mo vs. 24,3, p<0.0001), had significantly lower preoperative INR, lower bilirubin, lower WBC, lower PELD, lower graft GRWR (all p< 0.05). Patients with KPE had significantly higher incidence of preoperative cholangitis (p=0.007). Ascites, peritonitis, variceal bleeding, encephalopathy were similar between patients with and without KPE. Post-operative vascular and biliary complication rates, length of ICU stay and total length of stay were similar between patients with and without Kasai (p>0.05). Although mortality rate was higher in no KPE group (42,8% vs. 27.1%) this was not significant (p>0.05) (Table 1). There was statistically significant improvement in survival for patients who had transplant at or after 8 months of age (fig 1). There was a survival benefit trend in KPE group but this was not statistically significant. None of the variables, other than age of transplant, were associated with survival.

*Conclusions: KPE is justified as evidenced by improved physiological parameters and lower PELD scores at LT. BA patients have better survival after LT when transplanted after 8 months independent from KPE status. Larger cohort is necessary to improve the findings of this study.

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