Living donor (LD) liver transplantation (LT) provides better outcome than deceased donor (DD) in children less than two years with biliary atresia (BA): Results in 342 pediatric recipients

Background: BA is the main indication for LT in pediatric age. Donorselection strategy is still matter of debate. Methods: LT performed at our Institution between 1993 (beginning of our LDprogram) and 2015 were retrospectively analyzed. Patient and graft survivals were studied in BA patients according to age at LT and donor-type (LD vs DD). Among 609 children, recipients of 649 grafts, the indications for LT were as follows: BA (56.1%), cholestatic diseases (19.4%), liver malignancies (7.5%), fulminant hepatitis (4.3%) and others (12.7%). For BA recipients, 150 DD and 216 LD grafts were used. Results: Considering overall series: median age was significantly lower for BA (median: 1.0y; range: 0.3-15.7) comparing to other indications (3.9y; 0.1- 22.4) (p 2y-old (97.4%) comparing to those transplanted <2y-old (94.1%) (p = 0.9127); conversely, 5y graft survival was significantly better when LT was realized <2y-old (90.0% vs 84.1%) (p = 0.0316). In the subgroup of children <2y-old, 5y patient and graft survivals were significantly better after LD-LT (96.6% and 90.6% respectively), than after DD-LT (88.9% and 81.5%) (p = 0.0156 and p < 0.0001). Conclusions: 1) BA constituted the main indication for LT in children; 2) The use of LD-LT allowed to transplant children at younger age, when compared with DD-LT; 3) In the subgroup of BA children