Arch Surg 1988 Oct;123(10):1237-9

Orthotopic liver transplantation for biliary atresia. Evolution of management

Millis JM, Brems JJ, Hiatt JR, Klein AS, Ashizawa T, Ramming KP,
Quinones-Baldrich WJ, Busuttil RW
Department of Surgery, UCLA School of Medicine 90024.

Abstract
Forty-five patients with biliary atresia were accepted for orthotopic liver
transplantation. Nine patients died awaiting transplantation, and 36 underwent
transplantation. A portoenterostomy had been performed in 28 of these 36
patients, and its presence did not significantly affect the intraoperative blood
loss (5.6 vs 4.1 blood volumes), the need for retransplantation (21% vs 12%),
biliary complications (21% vs 12%), postoperative infections (36% vs 25%), or
survival (82% vs 63%). These results indicate that early portoenterostomy is
appropriate early therapy for biliary atresia; however, prompt referral to a
liver transplant center for evaluation at the first sign of cholestasis is
needed to attain optimal results for transplantation. Revisions of the
portoenterostomy prior to transplantation did not improve the longevity of the
procedure but did substantially increase complications and death after
orthotopic liver transplantation