Outcomes of liver transplantation for end-stage biliary disease: A comparative study with end-stage liver disease

Table 1 Aetiologies of liver transplantation in the two groups

Aetiology of liver transplant	Number
ESBD	43
Primary sclerosing cholangitis	1
Intrahepatic bile duct paucity	1
Alagille’s syndrome	1
Congenital biliary atresia	2
Caroli’s disease	2
Iatrogenic bile duct injury	2
Primary biliary cirrhosis	8
Cholelithiasis	8
Graft cholangiopathy	18
ESLD	86
Autoimmune cirrhosis	3
Drug-related cirrhosis	3
Hepatitis C virus-related cirrhosis	3
Wilson’s disease	4
Alcoholic cirrhosis	6
Hepatitis B virus-related cirrhosis	67

ESBD: End-stage biliary disease; ESLD: End-stage liver disease.

Table 2 Comparison of patient characteristics before surgery in the two groups

Index	ESBD group (n = 43)	ESLD group (n = 86)	P value
Age (yr)1	40.2 ± 15.5 (0.5-65)	43.2 ± 15.3 (5-65)	0.105
Gender (M:F)2	28:15 (65%:35%)	56:30 (65%:35%)	1.000
WBC (× 109/L)1	6.7 ± 4.3 (1.1-23.4)	6.1 ± 4.5 (1.3-24.5)	0.178
Hb (g/L)1	103.3 ± 22.6 (47.2-149)	102.3 ± 20.1 (55-154)	0.798
Plt (× 109/L)1	126.0 ± 59.6 (37-247)	91.0 ± 74. 6 (11-379)	0.000
TBIL (mg/dL)1	17.0 ± 13.8 (1.29-47.57)	9.4 ± 5.4 (0.96-22.16)	0.030
INR1	1.3 ± 0.4 (0.86-2.35)	1.829 ± 0.648 (1.12-5.57)	0.000
Cr (mg/dL)1	0.9 ± 0.8 (0.15-3.92)	1.1 ± 0.8 (0.35-5.06)	0.042
Alb (g/L)1	35.1 ± 4.7 (26-50.5)	33.4 ± 3.4 (28-44.3)	0.016
ALT (U/L)1	122.6 ± 96.3 (28-399)	112.9 ± 167.2 (26.5-1400)	0.156
γ-GT (U/L)1	515.7 ± 578.2 (17-2374)	119.9 ± 119.6 (11.7-588)	0.000
MELD/PELD score1	19.2 ± 6.6 (8-39)	22.0 ± 6.5 (11-38)	0.023
Previous surgery1	1.8 ± 1.3 (0-5)	0.1 ± 0.2 (0-1)	0.000

¹Data are presented as the mean ± SD; ranges are provided in the parentheses;

²Data are presented as the n (%). MELD risk score = [0.957 × log (creatinine; mg/L) + 0.378 × log (bilirubin; mg/dL) + 1.120 × log (INR) + 0.643] × 10. Used for patients aged 12 years and older. Laboratory values less than 1.0 were set to 1.0 to calculate the MELD score. PELD risk score = [0.48 × log (bilirubin; mg/dL) + 1.857 × log (INR) - 0.687 × log (albumin) + infants less than 1 year 0.436 + growth failure 0.667] × 10. Used for patients aged 11 years and younger. Laboratory values less than 1.0 were set to 1.0 to calculate the PELD score. WBC: White blood cell; Hb: Hemoglobin; PLT: Platelets; TBIL: Total bilirubin; INR: International normalised ratio; Cr: Serum creatinine; Alb: Albumin; ALT: Alanine transarninase; r-GT: Glutamyl transpeptidase; MELD: Model for end-stage liver disease; PELD: Paediatric end-stage liver disease.

Table 3 Comparison of operation conditions and postoperative hospital stay in the two groups

Index	ESBD group	ESLD group	P value
Operative time (min)1	527.4 ± 98.8 (300-720)	443.0 ± 101.0 (300-660)	0.000
Intraoperative blood loss (mL)1	3062.8 ± 2632.9 (200-12000)	2745.3 ± 1893.1 (500-10000)	0.751
Total complications2	17 (39.5)	27 (31.4)	0.358
Clavien-Dindo grade III
Hepatic artery embolisation	2	0
Re-operation for bile leakage	1	3
Intraabdominal bleeding	4	7
Hepatic vein stenosis	0	1
Bile duct stenosis	0	1
Portal vein embolisation	1	1
Intestinal fistula	2	0
Clavien-Dindo grade IV-V
Acute kidney failure	3	5
MODS	4	9
Intensive care time (d)1	12.74 ± 6.6 (6-41)	10.0 ± 7.5 (5-52)	0.000
Hospital stays (d)1	32.53 ± 7.5 (20-50)	30.42 ± 6.9 (18-52)	0.079

¹Data are presented as the mean ± SD, ranges are provided in parentheses;

²Data are presented as n (%). MODS: Multiple organ dysfunction syndrome.

Table 4 Causes of death after liver transplantation for patients in the end-stage biliary disease and end-stage liver disease groups

Cause of death	ESBD group		ESLD group
	n	Total deaths (%)	n	Total deaths (n)
Graft failure	3	7.0	4	4.7
Recurrent hepatitis	0	0.0	2	2.3
Biliary complication	2	4.7	2	2.3
Portal vein thrombosis	1	2.3	0	0.0
Multisystem organ failure	4	9.3	10	11.6
Cardiovascular	0	0.0	2	2.4
Myocardial infarction	0	0.0	1	1.2
Arrhythmia	0	0.0	1	1.2
Graft-vs-host disease	0	0.0	1	1.2
Upper gastrointestinal haemorrhage	0	0.0	1	1.2
Central nervous system	1	2.3	2	2.3
Epilepsy	1	2.3	0	0.0
Intracranial haemorrhage	0	0.0	1	1.2
Brain infarction	0	0.0	1	1.2
Lung cancer	1	2.3	0	0.0
Total	9	20.9	20	23.3

Some percentages do not sum to the correct totals because they were rounded up or down. LT: Liver transplantation; ESBD: End-stage biliary disease; ESLD: End-stage liver disease.

Table 5 Univariate and multivariate analyses of post-transplant survival with a Cox proportional hazard regression model for patients who underwent liver transplantation for end-stage biliary disease

Study variable	Univariate analysis			Multivariate analysis
	HR	95%CI	P value	HR	95%CI	P value
MELD/PELD score	1.213	1.081-1.362	0.001	1.132	1.005-1.275	0.041
WBC count	0.761	0.553-1.046	0.093	0.823	0.563-1.203	0.314
Blood loss	0.103	0.020-0.538	0.007	0.171	0.026-1.146	0.069

MELD: Model for end-stage liver disease; PELD: Paediatric end-stage liver disease; WBC: White blood cell.