Primary living donor liver transplantation outcome in biliary atresia patients: A single-center retrospective study from Indonesia

Background: Biliary atresia (BA) is the leading indication for liver transplantation in pediatric patients. Delayed diagnosis of BA in Indonesia causes the primary living donor liver transplantation (LDLT) rate to be higher than the other transplant centers worldwide. This study aimed to assess the primary LDLT outcome in BA patients in Cipto Mangunkusumo Hospital (CMH) and the associated influencing factors. Methods: This was a retrospective cohort study of pediatric BA patients who underwent primary LDLT from 2010 to 2019 in CMH. The observed data started from initial admission through initial discharge. The preoperative factors included in the analyses were age at transplant, sex, nutritional status, and Pediatric End-Stage Liver Disease Score. Morbidity and mortality were analyzed for preoperative and intraoperative prognostic factors. Results: 31 primary LDLT subjects were included in this study. The majority were males with a median age of 14 months and a mean PELD score of 17.09. Complications occurred in 96.7% of subjects with infection (90.3%) as the most common complication. Relaparotomy was performed in 54.8% of subjects. The median length of stay was 41 days. One-year post-transplantation mortality was 9.3%. There were statistically significant correlations between nutritional status and infection incidence (p = 0.003). Conclusion: Infection is the most common complication in primary LDLT patients in CMH with nutritional status serving as the influencing factor. Despite the complication rate, the one-year mortality rate is comparable to other transplantation centers worldwide. The incidence of relaparotomy and infectious complications are still major problems in newer, resource limited centers.