Determining the optimal timing of liver transplant for pediatric patients after Kasai portoenterostomy based on disease severity scores

• Published in: Journal of pediatric surgery Vol. 55; no. 9; pp. 1892 - 1896
• Main Authors: Chung, Patrick H.Y., Chok, Kenneth S.H., Wong, Kenneth K.Y., Tam, Paul K.H., Lo, Chung Mau
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-09-2020
• Subjects: Adolescent; Child; Child, Preschool; Female; Graft Survival; Humans; Infant; Liver - surgery; Liver Diseases - classification; Liver Diseases - diagnosis; Liver Diseases - surgery; Liver transplantation; Liver Transplantation - methods; Male; MELD score biliary atresia; PELD score; Portoenterostomy, Hepatic - methods; Postoperative Complications; Retrospective Studies; Severity of Illness Index; Time-to-Treatment; MELD score biliary atresia; PELD score; Liver transplantation
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2019.10.016

The objective of this study was to determine the most optimal timing of liver transplant (LT) for post-Kasai portoenterostomy (KPE) patients based on disease severity scores.
This was a retrospective study and the clinical data of all LT recipients aged <18 years (n = 89) with a history of KPE were analyzed. They were divided into three groups according to their PELD/MELD scores at the time of LT (A: <15; B: 15–25; C: >25). The effects of LT on the clinical outcomes and hospitalization status were analyzed.
There were 33, 34 and 22 patients in group A, B and C, respectively. There was no significant difference in 3-year graft survival rate between the three groups but group C patients had the highest incidence of vascular or biliary complications (p = 0.022). Group C patients had a significantly lower hospital admission frequency (p = 0.036) and shorter hospital stay (p = 0.041) after LT when compared with their pre-LT status and with non-LT patients with similar disease severity scores. On the other hand, the hospitalization frequency and duration were similar in patients with the lowest disease severity score (group A) before, after and without LT.
The benefit of LT was less obvious when the disease severity score is <15. A high complication rate was reported when LT was performed at a score > 25. Donor availability, the patient's general condition and parental wish should be considered during individual assessment.
Clinical research paper.
Level III.