Hepatic transplantation and biliary atresia: Early experience in eight patients

Recent improved results have raised interest in hepatic transplantation. Transplantation experience in patients with biliary atresia at the University of Minnesota is reported. These patients are frequently first seen when very small; rigorous metabolic support is used to optimize hepatic function and enhance weight gain while a donor is found. Preoperative exchange transfusion is performed as dictated by coagulation parameters; this minimizes operative blood loss. The operative procedure is performed as described by Starzl using a cholecystojejunostomy and aorto‐aortic anastomosis. Immunosuppression is achieved with cyclosporine and low‐dose prednisone. Weekly percutaneous biopsies provide an early indication of rejection which occurs frequently in these patients. Rejection is treated with bolus steroids and/or antilymphoblast globulin. Five of eight children with biliary atresia have returned to health after liver transplantation. Two deaths were related to difficulties with the donor hepatectomy and the last child died after erosion of a central venous catheter with cardiac tamponade. In this small series, early success after liver transplantation (>24 hours), predicted longterm survival.