scholarly journals Analysis of the odds ratio of developmental delay in children with biliary atresia 12 months after liver transplantation

2021 ◽  
Vol 23 (4) ◽  
pp. 8-12
Author(s):  
A. V. Syrkina ◽  
O. M. Tsirulnikova ◽  
I. E. Pashkova ◽  
O. V. Silina ◽  
E. V. Chekletsova ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Biliary Atresia ◽  
Developmental Delay ◽  
Psychomotor Development ◽  
Decompensated Cirrhosis ◽  
Kasai Portoenterostomy ◽  
Developmental Abnormalities ◽  
Before And After ◽  
Developmental Scale

Background. Liver cirrhosis occurring before 1 year of age can affect a child’s development. Liver transplantation is the only radical treatment for decompensated cirrhosis. In biliary atresia, cirrhosis develops during the first months of life. The duration of cirrhosis in biliary atresia may vary from palliative Kasai portoenterostomy (PE) to liver transplantation. Developmental abnormalities in children with biliary atresia have been shown to occur both before and after liver transplantation. Association between duration of liver cirrhosis and psychomotor development of children has been underestimated.Objective: to determine the chances of developmental delay in children depending on the cirrhosis persistence duration.Materials and methods. The study enrolled 83 children with biliary atresia (47 children underwent palliative Kasai PE, 36 children with liver transplantation did not undergo Kasai PE). All children had their psychomotor development assessed before PE and 12 months after PE using the Griffiths psychomotor developmental scale (translation and adaptation by E.S. Keshishian) for children up to 24 months of age. Statistical analysis was performed by calculating odds ratios with 95% confidence intervals.Results. Comparative analysis showed that in the subgroup of children who underwent Kasai PE, cirrhosis persistence before transplantation was 2.6 months longer than in children without Kasai PE (p = 0.011). The odds of developmental delay in preparation for liver transplantation were 3.3 times higher in the subgroup of children who underwent Kasai palliative PE compared to children without palliative (95%, CI 1.35–8.31). The odds of developmental delay 12 months after liver transplantation were 4.4 times higher in the subgroup of children who underwent palliative Kasai PE than in children without the palliative care (95% CI 1.54–12.5).Conclusion. Children who underwent liver transplantation after palliative surgical treatment had lower levels of psychomotor development than children without palliative Kasai PE both before and 12 months after liver transplantation (p = 0.0018, p = 0.01 respectively).

scholarly journals Neuropsychological development of children with biliary atresia after liver transplantation

2021 ◽  
Vol 23 (3) ◽  
pp. 66-72
Author(s):  
A. V. Syrkina ◽  
I. E. Pashkova ◽  
A. R. Monakhov ◽  
O. V. Silina ◽  
E. V. Chekletsova ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Surgical Treatment ◽  
Biliary Atresia ◽  
Psychomotor Development ◽  
Two Stage ◽  
Neuropsychological Development ◽  
One Stage ◽  
The Difference ◽  
Group 2 ◽  
Group 1

Background. In young children, the most common liver disease leading to transplantation is biliary atresia. Liver transplantation has fundamentally improved the survival rate of children with biliary atresia. Studies on developmental outcomes in children are mostly limited to small samples; there are no such studies in the Russian Federation.Objective: to determine the cognitive outcomes in children undergoing one-stage or two-stage surgical treatment of biliary atresia.Materials and Methods. 83 children were divided into groups: 36 children underwent transplantation without previous surgical interventions (group 1), 47 children underwent the Kasai palliative portoenterostomy (group 2). Inclusion criteria: 24 months of age or younger at the moment of transplantation, no medical history of neurological pathology. All children were examined before transplantation and at 1, 3, 6 and 12 months after liver transplantation. Psychomotor development was assessed using the Griffiths Psychomotor Development Scale for children under 24 months (translated by E.S. Keshishian), the Griffiths Intellectual Development Scale for children aged 2 to 8 years, and the Modified Checklist for Autism in Toddlers, Revised, for children 16-30 months old.Results. All children had developmental delays at the time of transplantation. Up to 50% of the children had signs of cachexia, with a shoulder circumference of less than 3 percentile. Only two children showed obvious hepatic encephalopathy in the form of depressed consciousness. After liver transplantation, 94% of group 1 children recovered their preoperative psychomotor development levels, and only 68% in group 2 made these gains. At 3 and 6 months after transplantation, about 80% of group 1 children showed normal psychomotor development, whereas in group 2, only 61% did. By 12 months after liver transplantation, the difference between the groups was more evident: 83.3% of group 1 children and only 53.2% of group 2 children were developing according to age. The difference between the groups was statistically significant (p < 0.05).Conclusion. Children who received one-stage treatment of biliary atresia and underwent liver transplantation have better neuropsychological development within a year after surgery than children with two-stage surgical treatment.

scholarly journals Living with biliary atresia: From Kasai portoenterostomy to liver transplantation

2016 ◽  
Vol 45 (2) ◽  
pp. 116
Author(s):  
Naresh P Shanmugam ◽  
Gomathy Narasimhan ◽  
Shaman Rajindrajith
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Kasai Portoenterostomy

scholarly journals Granulocyte Colony-stimulating Factor as Bridging Therapy for Pediatric Decompensated Liver Cirrhosis Prior to Liver Transplantation: an Open-label Randomised Controlled Trial

2021 ◽  
Author(s):  
Tri Hening Rahayatri ◽  
Aria Kekalih ◽  
Alida Harahap ◽  
Aryono Hendarto ◽  
Hanifah Oswari ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Liver Cirrhosis ◽  
Side Effects ◽  
Nutritional Status ◽  
Controlled Trial ◽  
Intervention Group ◽  
Decompensated Cirrhosis ◽  
Open Label ◽  
Decompensated Liver Cirrhosis ◽  
Interventional Group

Abstract Decompensated cirrhosis in children is a leading indication of liver transplantation (LT). Granulocyte-colony stimulating factor (G-CSF) therapy has shown promising results in adult decompensated cirrhosis. Our study aimed to investigate the effect of G-CSF on liver function, Pediatric End-stage liver disease (PELD) score, CD34+ cells mobilization, nutritional status, short-term side effects, and survival in children indicated for liver transplantation (LT).We performed an open-label, randomized controlled trial with decompensated liver cirrhosis between 3 months to 12 years old. The intervention group received a subcutaneous injection of G-CSF (5 μg/kg/day) for twelve courses in addition to standard medical treatment (SMT) for liver cirrhosis. We measured liver function, PELD scores, CD34+ cell mobilization, the change of leucocyte and neutrophil count, nutritional status, side effects, and survival within three months. Thirty-five pediatric patients were randomized into 17 interventional groups and 18 control groups. During the trial, 14 (82%) of the interventional group completed the intervention course. The median age was 18 months in the interventional group and 14.5 months in the control group. The alanine aminotransferase (ALT) level showed significant improvement in the intervention group, while other liver parameters, PELD score, nutritional status, and survival, did not. CD34+ cells mobilization rose in the interventional group but was statistically insignificant. Minor side effects of G-CSF were found in the intervention group.Multiple doses of G-CSF significantly improve ALT but did not improve PELD score, nutritional status, and survival in three months.

scholarly journals SERUM GH-BINDING PROTEIN BEFORE AND AFTER LIVER TRANSPLANTATION IN CHILDREN WITH CONGENITAL BILIARY ATRESIA

1993 ◽  
Vol 33 ◽  
pp. S52-S52
Author(s):  
C Yamanaka ◽  
S Uemoto ◽  
K Tanaka ◽  
H Kato ◽  
S Fujita ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Binding Protein ◽  
Before And After ◽  
Congenital Biliary Atresia ◽  
Serum Gh

Intrapulmonary shunting in biliary atresia before and after living-related liver transplantation

1999 ◽  
Vol 86 (9) ◽  
pp. 1139-1143 ◽  
Author(s):  
T. Yonemura ◽  
M. Yoshibayashi ◽  
S. Uemoto ◽  
Y. Inomata ◽  
K. Tanaka ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Biliary Atresia ◽  
Intrapulmonary Shunting ◽  
Living Related Liver Transplantation ◽  
Before And After ◽  
Living Related

Variceal Bleeds in Patients with Biliary Atresia

2017 ◽  
Vol 28 (05) ◽  
pp. 439-444 ◽  
Author(s):  
Mauri Witt ◽  
Niels Bax ◽  
Henkjan Verkade ◽  
René Scheenstra ◽  
Ruben de Kleine ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Portal Hypertension ◽  
Biliary Atresia ◽  
Variceal Bleeding ◽  
Laboratory Tests ◽  
Subsequent Development ◽  
Kasai Portoenterostomy ◽  
Receive Treatment ◽  
Related Mortality

Introduction Portal hypertension often occurs in biliary atresia (BA). The subsequent development of esophageal varices and bleeding from these varices are a well-known complication. We aim to describe the incidence and severity of variceal bleeding in patients with BA. In addition, we describe the characteristics of patients who experienced variceal bleeds. Materials and Methods We included all infants treated for BA at our center between March 1987 and August 2015. Variceal bleeding was defined as hematemesis and/or melena with presence of varices at endoscopy. Findings at endoscopy and ultrasound, laboratory tests, clearance of jaundice, fibrosis-grade at Kasai portoenterostomy, and several varices prediction scores were documented. Routine endoscopies were not performed. Results In this study, 74 patients were included. During follow-up, 18 out of 74 patients (24%) developed variceal bleeding at an age of 9 months (range, 4–111). Twelve patients were listed for liver transplantation at the time of bleeding. Patients who did not clear their jaundice developed variceal bleeds more often and earlier in life. Bleeds were treated with sclerotherapy, banding, or octreotide. Four patients did not receive treatment. No bleeding-related mortality occurred. Conclusion One-fourth of the children diagnosed with BA experience variceal bleeds during follow-up. Most of these children are younger than 1 year and often already listed for transplantation. Major complications did not occur after variceal bleeding.

scholarly journals 579. Prophylactic Antibiotics Did Not Decrease Recurrent Cholangitis in Patients with Biliary Atresia After Kasai Portoenterostomy

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S354-S355
Author(s):  
Thomas M Tarro ◽  
Laurie Song ◽  
Beth A Carter ◽  
Meiyu Yeh ◽  
Pia S Pannaraj ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Antibiotic Prophylaxis ◽  
Biliary Atresia ◽  
Panel Member ◽  
Prophylactic Antibiotics ◽  
Resistant Bacteria ◽  
Kasai Portoenterostomy ◽  
Research Support ◽  
Prophylaxis Group ◽  
Culture Positive

Abstract Background Biliary atresia (BA) is a rare, progressive, idiopathic, fibro-obliterative disease of the extrahepatic biliary tree seen in children. The current standard treatment is surgical management with Kasai portoenterostomy (KP). Bacterial cholangitis is a frequent complication following KP and an important determinant of long-term prognosis. Use of prophylactic antibiotics is common but not universal and efficacy is controversial. Methods A retrospective study was performed that included all patients with BA who underwent KP from November 2002 to July 2019. Chart review was conducted to collect demographic information and evaluate the use of antibiotic prophylaxis, number of cholangitis episodes, time to liver transplantation (LVT), and survival. Results Ninety-one patients with BA underwent KP during the study period. Seventy-two (79%) received prophylactic antibiotics, and 19 (21%) did not. The median duration of prophylactic antibiotics was 7 months (interquartile range [IQR] 8.5). Patients in the no-prophylaxis group had significantly fewer cholangitis episodes (median 0, IQR 1) than in the antibiotic prophylaxis group (median 1, IQR 2), p= 0.0201. The median time to LVT was 8 months (IQR 8.5) in the antibiotic prophylaxis group, compared to 7 months (IQR 6) in the no-prophylaxis group, p=0.8827. Of the patients who were on antibiotic prophylaxis, 57 (79.2%) received trimethoprim-sulfamethoxazole (TMP-SMX) alone and 15 (20.8%) received multiple/other antibiotics. Seven patients (7.7%) had culture-positive cholangitis. Six of 7 received prophylaxis with TMP-SMX and 5 of 7 grew bacteria that were resistant to TMP-SMX. No deaths occurred between the postoperative KP period to the time of LVT in both groups. Table 1. Characteristics of Patients in the Prophylaxis and No-prophylaxis Groups. Table 2. Impact of Prophylactic Antibiotics in the Period Between Kasai Portoenterostomy and Liver Transplantation. Table 3. Patients with Culture-positive Cholangitis after Kasai Portoenterostomy (n=7). Conclusion Antibiotic prophylaxis was frequently used after KP with TMP-SMX being the most common antibiotic used. Patients in the no-prophylaxis group had significantly fewer cholangitis episodes compared to those receiving antibiotic prophylaxis. Prophylactic antibiotics did not have an impact on time to LVT. Our findings suggest that antibiotic prophylaxis is not helpful in decreasing the frequency of cholangitis episodes after KP and may increase the risk for infections with resistant bacteria. Larger prospective randomized control studies are recommended. Disclosures Pia S. Pannaraj, MD, MPH, AstraZeneca (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Advisor or Review Panel member)

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