URGENT LIVER-TRANSPLANTATION FOR BILIARY ATRESIA - THE EXPERIENCE IN BICETRE

According to French rules for cadaver organ sharing, children with bil iary atresia (BA) complicated with acute necrosis (ALN) can be registe red on the waiting list for liver transplantation (LT) in a special in termediate grade urgent code. Over a 7 years period, 100 children have been submitted to elective LT for BA and 15 to urgent LT. Urgent proc edures accounted for 25%, of LT for BA in patients aged 0-2 years and 67% (8/12) in patients under 1 year of age. Children actuarial surviva l at 1, 12 and 48 months was respectively 66%, 60% and 60% versus 92%, 86% and 85%, deaths occuring earlier in the urgent group. Graft actua rial survival at 1, 12 and 48 months were 60%, 53% and 53% versus 85%, 77% and 76% (p <0.05), respectively. Outcome of children and grafts a fter LT is not significantly different in BA cases and in other urgent indications, excluding retransplantations. rn a LT program based on c adaver organ donation, allocation of in an urgent registration code to children with BA and ALN offers them more than 50% chance to escape d eath and does not result in wasting of grafts.