Liver transplantation in Japanese and Australian/New Zealand children with biliary atresia: a 10-year comparative study

Objective: To compare Japanese with Australian/New Zealand (ANZ) children with biliary atresia who were treated by liver transplantation, and evaluate the indications for and timing of transplantation. Design: Retrospective study. Setting: Queensland Liver Transplant Service (QLTS), Australia. Subjects: 43 Japanese and 30 ANZ children with biliary atresia who required transplantation between 1985 and 1992. Interventions: The 43 Japanese children had 52 transplants, and the 30 ANZ children had 33. Main outcome measures: Morbidity, mortality, and long term survival. Results: The Japanese children had significantly lower serum albumin concentrations than the ANZ children preoperatively (mean (SD) 32 (7) g/L compared with 37 (5), p < 0.05). The actuarial survival at 7 years of the ANZ children was significantly higher than that of the Japanese children (79% compared with 49%, p < 0.05). There were 24 deaths (17 Japanese, 40%, and 7 ANZ, 23%); 2 of the ANZ and 7 of the Japanese children died more than a year after transplantation. All 26 children who were well‐nourished at the time of transplantation defined as a Z‐score (weight or height minus mean weight or height for age, sex, and race, divided by the SD) of −1 or more were alive at 1 month compared with 11 of the 47 poorly‐nourished children (Z‐score