Biliary atresia is the most frequent cause of chronic cholestasis in infants. When left untreated, this condition leads to death from liver insufficiencywithin the first 2 yr of life. The modern therapeutic approach consists of a sequential strategy with Kasai portoenterostomy as a first step and, in case of failure, liver transplantation. After portoenterostomy, no more than 20% to 30% of patients w i l l live jaundice-free into adulthood. Illness in another third will be palliated, and these patients have extended survival, delaying liver transplantation to later childhood (2 to 15 yr). The remaining 30% to 40% will not benefit from the Kasai operation and will die of liver failure in infancy. The annual need of liver transplantation for biliary atresia is one case per million people. This indication represents 35% to 67% of the reported series of pediatric liver transplantation and between 5% and 10% of the indications for liver transplantation, all ages included. Approximately four of five children transplanted for biliary atresia will become long-term survivors with good physical and mental development; recurrence of the disease after transplantation has not been observed. Because most candidates are young children ( < 3 yr) of small size ( < 10 kg), there is a shortage of size-matched donors (which has been alleviated by the use of innovative techniques such as reduced and split livers). The resulting redistribution of the adult donor liver pool is ethically justified by the equal quality of the results after transplantation of a full-size or partial graft. (HEPATOLOGY 1994;20:41S-48S.)
Biliary atresia is the most frequent cause of chronic cholestasis in infants, affecting 1 : 8,000 to 1 : 12,000 live births (1, 2). It is a panbiliary disease affecting both the intrahepatic and extrahepatic biliary tree, probably the end result of a destructive inflammatory process leading to fibrosis and obliteration of the biliary tract (3) with development of secondary biliary cirrhosis. The condition has most likely an acquired pathogenesis.