Eur J Surg 1999 May;165(5):454-9

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

Ishikawa M, Lynch SV, Balderson GA, Shepherd RW, Ong TH, Strong RW
The Queensland Liver Transplantation Service, Brisbane, Australia 
Abstract
OBJECTIVE: To compare Japanese with Australian/New Zealand (ANZ) children with
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 concentrations than the ANZ children
preoperatively (mean (SD) 32 (7) g/L compared with 37 (5), p<0.05). The
actuarial survival at 7 years of the ANZ children was significantly higher than
that of the Japanese children (79% compared 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 after 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 association with Z-scores. Overall, Z-scores for weight improved
significantly after transplantation, whereas those for height improved a little,
but not significantly so. Japanese children were significantly shorter than ANZ
children, and their Z-scores for height did not improve after transplantation.
CONCLUSION: liver transplantation should be done as soon as possible for
children with biliary atresia to maximise survival and growth