Development in infants following living donor liver transplantation for biliary atresia

DOI IR HANDLE
  • KANAZAWA Ikue
    Division of Rehabilitathion, National Center for Child Health and Development
  • SASHIMA Tsuyoshi
    Faculty of Human Sciences, University of Tsukuba
  • KAWASHIMA Hitomi
    Division of Rehabilitathion, National Center for Child Health and Development
  • OKUBO Hiroko
    Division of Rehabilitathion, National Center for Child Health and Development
  • HASHIMOTO Keiji
    Division of Rehabilitathion, National Center for Child Health and Development
  • UCHIDA Hajime
    Organ Transplantation Center, National Center for Child Health and Development
  • FUKUDA Akinari
    Organ Transplantation Center, National Center for Child Health and Development
  • SAKAMOTO Seisuke
    Organ Transplantation Center, National Center for Child Health and Development
  • KASAHARA Mureo
    Organ Transplantation Center, National Center for Child Health and Development

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  • 1歳未満で生体肝移植をした胆道閉鎖症児の発達経過

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Abstract

<p>【Objective】 Significant improvements in survival and physical growth in infants following living donor liver transplantation (LDLT) for biliary atresia (BA) have been reported. However, cognitive and psychological development in infants after LDLT has not been well documented. We analyzed the physiological development of infantile transplant recipients with BA, especially those at one year post transplantation.</p><p>【Methods】 Eight BA patients younger than 1 year at the time of transplantation were enrolled between November 2013 and November 2014. All patients underwent physical therapy post transplantation. Psychophysical development was assessed using the Kyoto Scale of Psychological Development (KSPD) before the therapy, at the time of discharge, and one year after LDLT. The age of the patients ranged from 4 to 11 months. They had all received the diagnosis of type III BA and had undergone a Kasai portoenterostomy before age 5 months. The pediatric end-stage liver disease (PELD) score ranged from 6 to 21, and the Child-Pugh score was either grade B or C for all the patients.</p><p>【Results】 Five patients weighed less than −2SD preoperatively but approached the normal range in the following year. The height of one patient remained −2SD even one year after LDLT. All the patients had achieved head control and the ability to roll on the floor prior to the LDLT, and were able to walk within one year following the operation. The KSPD development quotient indicated that the postural-motor score was much lower than the cognitive-adaptive and language-social ability scores at the time of the LDLT and discharge but that it had improved one year later.</p><p>【Conclusion】 BA patients who received a LDLT in their infancy showed significant developmental delay even one year after the operation. These results suggest that perioperative management is necessary for normal psychosocial development in these patients.</p>

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