Urgent Liver Transplantation for Biliary Atresia: The Experience in Bicêtre
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FRÉDÉRIC GAUTHIER1,
CHRISTOPHE CHARDOT1,
SOPHIE BRANCHEREAU1,
YUMI OKAWA1, OLIVIER
DE DREUZY1, DIDIER
JACOLOT2, DENIS
DEVICTOR3, DOMINIQUE
DEBRAY4 and JACQUES
VALAYER1
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1Service de Chirurgie Pédiatrique, 2Départment d'Anesthésie-Réa
nimation, 3UnitEde Soins Intensifs pour Enfants, 4Service d'Hépatologie
Pédiatrique, Centre Hospitalier Universitaire Bicêtre, FacultEde Médecine Paris Sud,
UniversitEParis 11, Le Kremlin Bicêtre, France
According to French rules for cadaver organ sharing, children with biliary atresia (BA)
complicated with acute necrosis (ALN) can be registered on the waiting list for liver
transplantation (LT) in a special intermediate grade urgent code. Over a 7 years period, 100
children have been submitted to elective LT for BA and 15 to urgent LT. Urgent procedures
accounted for 25% of LT for BA in patients aged 0-2 years and 67% (8/12) in patients under I
year of age. Children actuarial survival at l, 12 and 48 months was respectively 66%, 60%
and 60% versus 92%, 86% and 85%, deaths occuring earlier in the urgent group. Graft
actuarial survival at l, 12 and 48 months were 60%, 53% and 53% versus 85%, 77% and 76%
(p<0.05), respectively. Outcome of children and grafts after LT is not significantly
different in BA cases and in other urgent indications, excluding retransplantations. In a LT
program based on cadaver organ donation, allocation of in an urgent registration code to
children with BA and ALN offers them more than 50% chance to escape death and does not
result in wasting of grafts.
Key word(s)---
biliary atresia; acute liver failure; liver transplantation
Tohoku J. Exp. Med., 1997, 181, 129-138
Address for reprints:
Professeur Frédéric Gauthier, Service de Chirurgie Pédiatrique, Centre Hospitalier
Universitaire Bicêtre 78, rue du Général Leclerc, F94275 Le Kremlin Bicêtre Cedex, France.
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