PMID- 30208381
OWN - NLM
STAT- MEDLINE
DCOM- 20191125
LR  - 20200309
IS  - 2168-6262 (Electronic)
IS  - 2168-6254 (Print)
IS  - 2168-6254 (Linking)
VI  - 154
IP  - 1
DP  - 2019 Jan 1
TI  - Biliary-Enteric Drainage vs Primary Liver Transplant as Initial Treatment for 
      Children With Biliary Atresia.
PG  - 26-32
LID - 10.1001/jamasurg.2018.3180 [doi]
AB  - IMPORTANCE: Some infants with biliary atresia are treated with primary liver 
      transplant (pLT), but most are initially treated with biliary-enteric drainage 
      (BED) with a subsequent salvage liver transplant. Given the improvements in liver 
      transplant outcomes, it is important to determine whether BED treatment remains 
      the optimal surgical algorithm for patients with biliary atresia. OBJECTIVE: To 
      compare the survival of patients with biliary atresia initially treated with BED 
      with patients who underwent pLT. DESIGN, SETTING, AND PARTICIPANTS: This cohort 
      study used deidentified records from the California Office of Statewide Health 
      Planning and Development database to identify patients with biliary atresia 
      (n = 1252) between January 1, 1990, through December 31, 2015. Patients were 
      categorized into 1 of 2 cohorts: those who received BED treatment and those who 
      underwent pLT. Excluded from the study were those born before January 1, 1995, 
      and those without any documented operative intervention by age 5 years. Data 
      analysis was performed from January 1, 1990, to December 31, 2015. MAIN OUTCOMES 
      AND MEASURES: Overall survival was compared between the BED and pLT cohorts using 
      the Kaplan-Meier method. The treatment's association with treatment era was 
      examined by comparing survival before 2002 and on or after January 1, 2002. 
      RESULTS: In total, 1252 patients with biliary atresia were identified. After 
      exclusions, 626 remained; of these patients, 351 (56.1%) were female and 275 
      (43.9%) were male with a median (interquartile range) age at intervention for 
      initial BED treatment of 65 (48-81) days. Among the 626 patients studied, initial 
      BED treatment was performed in 313 patients (50.0%), and pLT was performed in 313 
      patients (50.0%). Although patients who underwent pLT had a higher mortality rate 
      within the first 3 months after the procedure, they had a reduced risk of 
      long-term mortality compared with patients initially managed with BED treatment 
      (hazard ratio [HR] >/=6 months after the initial procedure, 0.19; 95% CI, 
      0.08-0.42; P = .01). Patients requiring salvage liver transplant had a 
      substantially higher risk of mortality than patients who received pLT (HR, 0.43; 
      95% CI 0.25-0.76; P = .003). Those who underwent pLT had superior survival 
      compared with BED treatment recipients on or after 2002 (HR, 0.16; 95% CI, 
      0.05-0.54; P < .001), and that persisted when censoring patients who underwent 
      salvage liver transplant (HR, 0.23; 95% CI, 0.07-0.82; P = .01). CONCLUSIONS AND 
      RELEVANCE: Patients who underwent pLT experienced superior long-term survival 
      compared with patients who underwent BED treatment. Multi-institutional trials 
      are needed to determine which initial treatment is most advantageous to patients 
      with biliary atresia.
FAU - LeeVan, Elyse
AU  - LeeVan E
AD  - Department of Surgery, Huntington Memorial Hospital, Pasadena, California.
FAU - Matsuoka, Lea
AU  - Matsuoka L
AD  - Division of Hepatobiliary and Liver Transplantation, Vanderbilt University 
      Medical Center, Nashville, Tennessee.
FAU - Cao, Shu
AU  - Cao S
AD  - Department of Preventive Medicine, Keck Hospital, University of Southern 
      California, Los Angeles.
FAU - Groshen, Susan
AU  - Groshen S
AD  - Department of Preventive Medicine, Keck Hospital, University of Southern 
      California, Los Angeles.
FAU - Alexopoulos, Sophoclis
AU  - Alexopoulos S
AD  - Division of Hepatobiliary and Liver Transplantation, Vanderbilt University 
      Medical Center, Nashville, Tennessee.
LA  - eng
PT  - Comparative Study
PT  - Evaluation Study
PT  - Journal Article
PL  - United States
TA  - JAMA Surg
JT  - JAMA surgery
JID - 101589553
SB  - IM
CIN - Hepatology. 2020 Feb;71(2):751-752. PMID: 31517392
MH  - Biliary Atresia/mortality/*surgery
MH  - California
MH  - Drainage/*methods/mortality
MH  - Female
MH  - Humans
MH  - Infant
MH  - Kaplan-Meier Estimate
MH  - Liver Transplantation/*methods/mortality
MH  - Male
MH  - Risk Factors
MH  - Salvage Therapy/methods/mortality
PMC - PMC6439864
COIS- Conflict of Interest Disclosures: None reported.
EDAT- 2018/09/13 06:00
MHDA- 2019/11/26 06:00
PMCR- 2019/09/12
CRDT- 2018/09/13 06:00
PHST- 2018/09/13 06:00 [pubmed]
PHST- 2019/11/26 06:00 [medline]
PHST- 2018/09/13 06:00 [entrez]
PHST- 2019/09/12 00:00 [pmc-release]
AID - 2698957 [pii]
AID - soi180054 [pii]
AID - 10.1001/jamasurg.2018.3180 [doi]
PST - ppublish
SO  - JAMA Surg. 2019 Jan 1;154(1):26-32. doi: 10.1001/jamasurg.2018.3180.