Objective To evaluate the
clinical efficacy of
liver transplantation in
children with
Alagille syndrome (ALGS).
Methods Clinical data of 12
children with ALGS were collected and retrospectively analyzed. Clinical characteristics of
children with ALGS, pathological characteristics of
liver tissues, characteristics of
liver transplantation,
postoperative complications and follow-up of
children with ALGS were analyzed. Results JAG1
gene mutation and typical facial features was present in all 12
children.
Jaundice was the most common initial symptom, which occurred at 7 (3, 40) d after
birth. Upon
liver transplantation, the Z scores of height and
body weight were calculated as -2.14 (-3.11, -1.83) and -2.32 (-3.12, -1.12). Five
children developed severe
growth retardation and 4
children with severe
malnutrition. Eight of 12
children were diagnosed with
cardiovascular abnormalities. Pathological examination showed that the lobular structure of the diseased
livers of 4
children was basically maintained, and 8 cases of nodular
liver cirrhosis in different sizes including 1 case of single early moderately-differentiated
hepatocellular carcinoma. Three
children were misdiagnosed with
biliary atresia and underwent Kasai portoenterostomy. Eight
children underwent
living donor liver transplantation, three
children underwent cadaveric
donor liver transplantation (two cases of split
liver transplantation and one case of cadaveric total
liver transplantation), and one
child underwent domino
liver transplantation (
donor liver was derived from a
patient with
maple syrup urine disease). during the follow-up of 30.0(24.5, 41.7) months, the
survival rates of the
children and
liver grafts were both 100%. During postoperative follow-up, the Z scores of height and
body weight were calculated as -1.24 (-2.11, 0.60) and -0.83 (-1.65, -0.43), indicating that the
growth and development of the
children were significantly improved after operation. Conclusions
Liver transplantation is an efficacious
treatment for
children with ALGS complicated with decompensated
cirrhosis, severe
itching and poor
quality of life. For
children with ALGS complicated with
cardiovascular abnormalities, explicit preoperative evaluation should be delivered, and
consultation with pediatric
cardiologists should be performed if necessary.