A Case Report of Successful Semi-Emergent Living Donor Liver Transplantation for Biliary Atresia With Uncontrollable Gastrointestinal Bleeding From the Roux-Y Jejunum : The Optimal Timing of Liver Transplantation for Biliary Atresia With Portal Hypertension

Abstract

In patients who become jaundice-free following a Kasai portoenterostomy (KP) for biliary atresia (BA), the present issue remains the optimal timing for liver transplantation (LT). In the present case, we reported the timing of LT for BA patients with portal hypertension. The patient was a 14-year-old female patient with BA. The patient became jaundice-free following KP, but suffered from progressive portal hypertension. Although the patient underwent endoscopic variceal ligation and partial spleen embolization for portal hypertension, semi-emergent living donor liver transplantation was performed because she suffered from uncontrollable gastrointestinal bleeding from the Roux-Y jejunum. There is a possibility that symptomatic treatment can lead to the development of other collateral veins, because portal hypertension after KP is either progressive or maintainable unless liver cirrhosis can be improved. Even if the patients with BA become jaundice-free following KP, the evaluation of esophageal and gastrointestinal varices should be performed, and LT should be prepared for the patients who suffer from portal hypertension because of uncontrollable gastrointestinal bleeding.