CLDF Title
Home | Contact Us | Bookmark
NASH HCC
Centers of Educational Expertise  
Live CME Events Webcasts Slide Library Abstract Library CLDF 2019 Year in Review Conference Highlights
 
Back  
 
Reuters Health Information: Primary liver transplant may best drainage in infants with biliary atresia

Primary liver transplant may best drainage in infants with biliary atresia

Last Updated: 2018-09-20

By David Douglas

NEW YORK (Reuters Health) - Primary liver transplantation is associated with better long-term survival than is biliary-enteric drainage (BED) in infants with biliary atresia, according to a new study.

In the past, the high mortality rate with transplant "relegated it to a salvage procedure reserved for patients whose BED treatment was unsuccessful," Dr. Sophoclis Alexopoulos of Vanderbilt University Medical Center, in Nashville, Tennessee, and colleagues write in JAMA Surgery, online September 12. However, advances in care have meant that a subset of infants have gone directly to transplantation.

To compare the two approaches, the researchers tapped into Californian health data covering 1990 to 2015 on 313 patients who initially underwent BED at a median age of 65 days and a further 313 who underwent primary transplantation.

The primary-transplant group had a higher three-month mortality than the BED group. However, at six months and beyond, their mortality rate was significantly lower (hazard ratio, 0.19).

In addition, the 147 BED patients (46.9%) who subsequently underwent a transplant had a substantially higher mortality rate than the primary-transplant group (HR, 0.43).

Because of considerable changes in liver allocation over the course of the study period, the researchers also compared survival in recipients from 2002. This continued to show the superiority of primary transplantation (HR, 0.16), even when censoring patients who underwent salvage liver transplant (HR 0.23).

As expected, say the researchers, between the earlier and later periods "no substantial improvement was noted in the survival of patients who received BED treatment."

Dr. Alexopoulos told Reuters Health by email, "The current excellent outcomes of pediatric liver transplantation raise the question of whether biliary drainage through hepatic portoenterostomy, with its high associated failure rate requiring salvage liver transplantation, should still be the initial treatment of choice for all infants with biliary atresia."

"A prospective multi-institutional trial needs to be performed to identify which patients would benefit most from a biliary drainage procedure and which should proceed directly to a primary liver transplant," he concluded.

SOURCE: https://bit.ly/2NZV5QH

JAMA Surg 2018.

 
 
 
 
                               
 
HEPATITIS
HBV
HCV
HDV
 
 
HCC
Slide Library
Abstract Library
 
HE
Webcasts
Slide Library
Abstract Library
 
HRS
Webcasts
Slide Library
Abstract Library
 
NASH
Webcasts
Slide Library
Abstract Library
 
 
PBC
Webcasts
Slide Library
Abstract Library
 
 
THROMBOCYTOPENIA
Webcasts
Slide Library
   
   
 
About CLDF
Mission Statement
Board of Trustees
Board of Advisors/Faculty
2019 GI Fellow Board of Advisors
 
Other Resources
Liver News Library
Journal Abstracts
Hep C Link to Care
 
Centers of
Educational Expertise
Hepatology
Substance Use Disorder
             
CLDF Follow Us
   
  The Chronic Liver Disease Foundation is a non-profit organization with content developed specifically for healthcare professionals.
© Copyright 2012-2021 Chronic Liver Disease Foundation. All rights reserved. This site is maintained as an educational resource for US healthcare providers only.
Use of this Web site is governed by the Chronic Liver Disease Foundation terms of use and privacy statement.