Deceased donor (DD) vs living donor (LD) liver transplantation (LT) for biliary atresia (BA). Experience in 342 patients

Tambucci, R [UCL] Szabo, M [UCL] de Magnee, Catherine [UCL] Pire, A [UCL] Janssen, M [UCL] Ciccarelli, O [UCL] Riani, E.B. [UCL] Coubeau, Laurent [UCL] Stephenne, Xavier [UCL] Scheers, Isabelle [UCL] Smets, Françoise [UCL] Sokal, Etienne [UCL] Reding, Raymond [UCL]

Introduction: Biliary atresia (BA) is the main indication for liver transplantation (LT) in the pediatric age. Donor-selection strategy is still matter of debate. Methods: LT performed at our Institution between 1993-beginning of our living donor program-and 2015 were retrospectively analyzed. Patient and graft survivals were studied in BA patients according to age at LT (before and after 2 years-old) and type of donor (living donor vs deceased donor). Among 609 children, recipients of 649 grafts, the indications for LT were as follows: BA (56.1%), cholestatic diseases (19.4%), liver malignancies (7.5%), fulminant hepatitis (4.3%) and others (12.7%). For BA recipients, 150 DD and 216 LD grafts were used: only primary transplantations (342 grafts) were considered for this study. Results: Overall, the median age at LT was significantly lower for BA patients (median: 1.0 year; range: 0.3-15.7) comparing to other indications (3.9 years; 0.1-22.4) (P < 0.0001). Overall 5-year patient and graft survivals were 86.9% and 82.2% respectively for non-BA, vs 95.1%% and 88.8% for BA patients (P = 0.0001 and P = 0.0033). In the BA subgroup (n = 342 pts), the median age was significantly lower when a LD-LT was performed (0.9 years; 0.4-10.8) comparing to DD-LT (1.4 years; 0.3-15.7) (P < 0.0001). 264 patients have been transplanted < 2 years-old (183 LD and 81 DD) and 78 ≥ 2 years-old (31 LD and 47 DD). Overall re-transplantation rate in BA recipients was 9.3%. 5-year PATIENT survival was comparable for patients transplanted ≥ 2 years-old (97.4%) vs those transplanted < 2 years-old (94.1%) (P = 0.9127); conversely, 5-years GRAFT survival was significantly higher when LT was performed < 2 years-old (90.0% vs 84.1%) (P = 0.0316). In the subgroup of children < 2 years-old, 5-year patient and graft survivals were significantly higher after LD-LT (96.6% and 90.6% respectively), than after DD-LT (88.9% and 81.5%) (P = 0.0156 and P < 0.0001). Conclusions: 1) BA constituted the main indication for LT in children, for whom outcome seems to be better comparing to those transplanted for all other indications; 2) The use of LD-LT allowed to transplant children at a younger age, when compared with DD-LT, with a comparable patient survival rate, but with a better graft survival rate; 3) In the subgroup of BA children transplanted earlier (< 2 years-old), LD-LT provides significantly better outcome in both patient and graft survival rate.