Xie Zhenyu, Chen Yang, Peng Yun, Luo Chengkun, Xiang Bo, Yang Jiayin, Song Jiulin, Jin Shuguang
Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, 610041, China.
Department of Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
BMC Pediatr. 2025 Aug 4;25(1):594. doi: 10.1186/s12887-025-05959-0.
To analyze and compare the efficacy of two treatment strategies for biliary atresia (BA) sequential treatment of Kasai hepatoportoenterostomy-liver transplantation and primary liver transplantation.
A retrospective analysis was conducted on the clinical data of 300 patients with BA who underwent LT in our center. Among these patients, 225 underwent Kasai hepatoportoenterostomy - liver transplantation sequential treatment (Kasai-LT group), while 75 received primary liver transplantation (pLT group). Data on demographic characteristics, perioperative conditions, postoperative recovery, and complications were collected to analyze the efficacy, complication rates, and survival outcomes of the two treatment approaches.
After propensity score matching analysis, there were no differences in postoperative liver function recovery between two groups. However, the Kasai-LT group had lower APRI, lower γ-GT level, and lower PELD scores when liver transplantation. The Kasai-LT group had shorter operative time, shorter PICU stay, shorter hospital stay with lower hospitalization cost. The incidence of hepatic artery complications and thoracoabdominal infections after LT was significantly higher in the pLT group compared to the Kasai-LT group. The 5-year recipient cumulative survival rate was 94.40% in the Kasai-LT group compared to 88.10% in the pLT group. Furthermore, the 5-year cumulative graft survival rate was 89.30% in the Kasai-LT group and 86.80% in the pLT group.
The treatment of BA should follow Kasai-LT sequential treatment combined with individualized treatment plans to achieve better pre-transplantation general condition and reduce the incidence of postoperative complications.
分析和比较两种治疗策略对胆道闭锁（BA）的疗效，即Kasai肝门肠吻合术 - 肝移植序贯治疗与原位肝移植。
对在本中心接受肝移植的300例BA患者的临床资料进行回顾性分析。其中，225例行Kasai肝门肠吻合术 - 肝移植序贯治疗（Kasai - LT组），75例接受原位肝移植（pLT组）。收集人口统计学特征、围手术期情况、术后恢复及并发症等数据，以分析两种治疗方法的疗效、并发症发生率和生存结局。
倾向评分匹配分析后，两组术后肝功能恢复情况无差异。然而，Kasai - LT组在肝移植时APRI较低、γ - GT水平较低、PELD评分较低。Kasai - LT组手术时间较短、PICU住院时间较短、住院时间较短且住院费用较低。与Kasai - LT组相比，pLT组肝移植后肝动脉并发症和胸腹感染的发生率显著更高。Kasai - LT组5年受者累积生存率为94.40%，pLT组为88.10%。此外，Kasai - LT组5年移植肝累积生存率为89.30%，pLT组为86.80%。
BA的治疗应采用Kasai - LT序贯治疗并结合个体化治疗方案，以获得更好的移植前一般状况并降低术后并发症的发生率。
