ObjectiveTo investigate the effect of perioperative intravenous immunoglobulin (IVIG) on the reduction of blood group antibody titer and prognosis in children with ABO incompatible (ABO-I) liver transplantation.MethodsA retrospective study was conducted in 20 children undergoing ABO-I liver transplantation in Beijing Friendship Hospital Affiliated to Capital Medical University from July 2017 to March 2020. The changes of blood group antibody titer, alanine aminotransferase, and total bilirubin before and after operation, as well as survival rate were analyzed after intravenous IVIG during perioperative period.ResultsAfter ABO-I liver transplantation, the 1-year survival rate of 20 patients was 100%, and 1 case (5%) developed immune rejection. Compared with before operation, on the day of operation, IgM blood group antibody titer did not change in 4 cases (20%), increased in 1 case (5%), and decreased in 15 cases (75%); in one week after operation: 12 cases (60%) decreased, 5 cases (25%) increased, and 3 cases (15%) remained unchanged; in one month after operation: 18 cases (90%) decreased , 2 cases (10%) remained unchanged. Compared with before operation, the titer of IgG blood group antibody increased in 2 cases (10%), remained unchanged in 6 cases (30%), and decreased in 12 cases (60%); in one week after operation: 4 cases (20%) increased, 4 cases (20%) remained unchanged, and 12 cases (60%) decreased; in one month after operation: 3 cases (15%) increased, 4 cases (20%) remained unchanged, and 13 cases (65%) decreased. The levels of alanine aminotransferase and total bilirubin in 1 month after operation were lower than those on the day of operation.ConclusionThe effect of IVIG on reducing blood group antibody titer in children after ABO-I liver transplantation is not obvious, and its actual clinical effect needs to befurther confirmed.
ObjectiveTo compare the efficacy of two regimens of biliary atresia treated with Kasai-liver transplantation (LT) sequential therapy and direct primary LT. MethodsA retrospective study was conducted on pediatric patients diagnosed with biliary atresia who underwent LT and met the inclusion and exclusion criteria at the Department of Pediatric Surgery, West China Hospital, Sichuan University, from January 2018 to January 2025. The enrolled children were divided into two groups according to treatment regimens: the Kasai-LT group and the direct primary LT group. Demographic data, general clinical data, intraoperative conditions, postoperative recovery, complications, and survival rates were compared between the two groups. ResultsA total of 300 pediatric patients were enrolled, including 225 in the Kasai-LT group and 75 in the primary LT group. After propensity score matching, there were 150 patients in the Kasai-LT group and 75 in the primary LT group. In terms of surgical parameters, the Kasai-LT group had a shorter operative time (P=0.005), stay in the pediatric intensive care unit (P=0.026), and total hospital stay (P=0.015), as well as lower hospitalization costs (P=0.017). No significant differences were observed in liver function recovery on postoperative day 7 between the two groups (P>0.05). The Kasai-LT group presented lower incidences of hepatic artery complications and thoracic and abdominal infections compared with the primary LT group (P=0.023 and P=0.003, respectively). The 5-year cumulative survival rates were 94.40% for the Kasai-LT group and 88.10% for the primary LT group, while the 5-year cumulative graft survival rates were 89.30% and 86.80%, respectively. No statistically significant differences were found between the two groups for either indicator (P>0.05). ConclusionsKasai procedure for biliary atresia can effectively improve LT conditions and reduce the rate of postoperative complications. For the treatment of biliary atresia, sequential Kasai procedure combined with LT is a viable option, and individualized therapeutic regimens should also be adopted.