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Evolution of Management

J. Michael Millis, MD; John J. Brems, MD; Jonathan R. Hiatt, MD; Andrew S. Klein, MD; Tatsuto Ashizawa, MD; Kenneth P. Ramming, MD; William J. Quinones-Baldrich, MD; Ronald W. Busuttil, MD, PhD

Arch Surg. 1988;123(10):1237-1239.

Abstract
• Forty-five patients with biliary atresia were accepted for orthotopic liver transplantation. Nine patients died awaiting transplantation, and 36 underwent transplantation. A portoenterostomy had been performed in 28 of these 36 patients, and its presence did not significantly affect the intraoperative blood loss (5.6 vs 4.1 blood volumes), the need for retransplantation (21% vs 12%), biliary complications (21% vs 12%), postoperative infections (36% vs 25%), or survival (82% vs 63%). These results indicate that early portoenterostomy is appropriate early therapy for biliary atresia; however, prompt referral to a liver transplant center for evaluation at the first sign of cholestasis is needed to attain optimal results for transplantation. Revisions of the portoenterostomy prior to transplantation did not improve the longevity of the procedure but did substantially increase complications and death after orthotopic liver transplantation.

(Arch Surg 1988;123:1237-1239)

Author Affiliations
From the Department of Surgery, UCLA School of Medicine.

Footnotes
Accepted for publication April 12, 1988.

Read before the Annual Meeting of the Southern California Chapter of the American College of Surgeons, Newport Beach, Calif, Jan 22, 1988.

Reprint requests to Room 72-132 CHS, UCLA Medical Center, Los Angeles, CA 90024 (Dr Busuttil).

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ABSTRACT