Liver transplantation in Japanese and Australian/New Zealand children withbiliary atresia: a 10-year comparative study

Objective: To compare Japanese with Australian/New Zealand (ANZ) children w ith biliary atresia who were treated by liver transplantation, and evaluate the indications for and timing of transplantation. Design: Retrospective study. Setting: Queensland Liver Transplant Service (QLTS), Australia. Subjects: 43 Japanese and 30 ANZ children with biliary atresia who required transplantation between 1985 and 1992. Interventions: The 43 Japanese children had 52 transplants, and the 30 ANZ children had 33. Main outcome measures: Morbidity, mortality, and long term survival. Results: The Japanese children had significantly lower serum albumin concen trations than the ANZ children preoperatively (mean (SD) 32 (7) g/L compare d with 37 (5), p < 0.05). The actuarial survival at 7 years of the ANZ chil dren was significantly higher than that of the Japanese children (79% compa red with 49% p < 0.05). There were 24 deaths (17 Japanese, 40%, and 7 ANZ, 23%); 2 of the ANZ and 7 of the Japanese children died more than a year aft er transplantation. All 26 children who were well-nourished at the time of transplantation defined as a Z-score (weight or height minus mean weight or height for age, sex, and race, divided by the SD) of -1 or more were alive at 1 month compared with 11 of the 47 poorly-nourished children (Z-score < -1). Survival among the Japanese declined after 1 year, and there was no as sociation with Z-scores. Overall, Z-scores for weight improved significantl y after transplantation, whereas those for height improved a little, but no t significantly so. Japanese children were significantly shorter than Am ch ildren, and their Z-scores for height did not improve after transplantation . Conclusion: liver transplantation should be done as soon as possible for ch ildren with biliary atresia to maximise survival and growth.