1. Pretransplant risk factors and optimal timing for living-related liver transplantation in biliary atresia: experience of one Japanese children's hospital and transplantation center.
- Author
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Okamoto, Tatsuya, Yokoi, Akiko, Okamoto, Shinya, Takamizawa, Shigeru, Satoh, Shiiki, Muraji, Toshihiro, Uemoto, Shinji, and Nishijima, Eiji
- Subjects
LIVER transplantation ,BILIARY atresia ,BLOOD gases ,OXIMETRY - Abstract
Abstract: Background/Purpose: Although living-related liver transplantation (LRLT) is effective for patients with biliary atresia (BA) after a failed Kasai operation, the pretransplant factors affecting post-LRLT mortality and the optimal timing of the procedure remain unclear. Method: A retrospective review of 27 patients with BA after a failed Kasai operation (median age, 22 months; range, 6-237 months) who received LRLT from 1994 to 2005 was done. The clinical characteristics at the time of the pre-LRLT assessment of those who did and did not survive were compared. A simple regression analysis and receiver operating characteristic analysis were done to correlate the clinical data. Results: Among the 27 patients, 4 patients died within 1 year post-LRLT. The significant factors affecting posttransplant death were hepatopulmonary syndrome (HPS), age at LRLT, and graft-to-recipient weight ratio. The arterial blood gas analysis of HPS patients showed that there was a significant negative correlation between the Sao
2 value on room air and the intrapulmonary shunt ratio. The receiver operating characteristic analysis of age at LRLT showed that the optimal cutoff point was 103 months of age. Conclusion: Older children with HPS or a lower graft-to-recipient weight ratio are not ideal candidates for LRLT. The correlation between the shunt ratio and Sao2 suggests that HPS could be detected early using pulse oximetry. [Copyright &y& Elsevier]- Published
- 2008
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