Text Box: PAEDIATRIC LIVER TRANSPLANTATION FOR BILIARY ATRESIA AFTER FAILED PORTOENTEROSTOMY
Chan KL, Fan ST, Saing H, Wei W, Lo CM, Tso WK*, Yuen KY**, Ng I***, Tam PKH and Wong J 
Departments of Surgery, Radiology*, Microbiology** and Radiology***, University of Hong Kong Medical Center, Queen Mary Hospital, Hong Kong SAR, China

Objective: To review the results of liver transplantation  (LT) for paediatric patients with biliary atresia after failed portoenterostomy.
Methods: The medical records of the patients who had LT for their biliary atresia failed portoenterostomy were reviewed.
Results: There were 21 patients (9 boys and 12 girls) with 22 LT performed after failed portoenterostomy from 1991 to 2001. One patient developed non-specific hepatitis after LT and needed a retransplantation. Their ages at transplantation ranged from 7 months to 132 months (median: 11 m) and their body weight ranged from 6.1 kg to 25 kg (median: 9.9 kg). The ratio of reduced size LT to living related LT was 9 to 13. Morbidity included postoperative haemorrhage (n=7), biliary-enteric anastomosis stenosis (n=3), portal vein thrombosis (n=1), portal vein stenosis (n=2), and intestinal perforation (n=1). There were 3 deaths caused by ruptured intrahepatic artery aneurysm (n=1), pulmonary failure (n=1) and hepatic vein stenosis leading to liver failure (n=1). Their ages ranged from 5.5 to 11.5 years (median: 7.5 yrs). All other surviving patients have normal liver function. The median follow-up time is 5.5 years (range: 1 m to 10 yrs). The survival rate is 85.7% (18/21). All living donors were discharged home on day 4 to day 7. They are well and have returned to their original work.
Conclusions: Liver transplantation is a viable option for treating patients with biliary atresia after failed portoenterostomy even in infancy.    
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