148 HEPATIC ARTERY RESISTANCE INDEX PREDICTS EARLY DEATH IN BILIARY ATRESIA:

Despite innovative surgery providing more organs suitable for paediatric liver transplantation (OLT), there is still a significant shortfall in the number available. Biliary atresia (BA) is the commonest condition for which OLT is indicated in childhood. In order to optimise results, patients recognised to be at risk of rapid deterioration require early listing for OLT while they are in good clinical condition, and should be given priority for organs. Hepatic artery resistance index (RI) was measured by ultrasound Doppler in children with BA. 37 were identified between 1987 and 1994 with R1≥1. Clinical, biochemical, ultrasonographic and outcome data were available in 32 (group A) mean age 0.87 yr; 15 male. These data were compared with 32 age matched patients with BA and RI<1.0 (group B). Group A was found to have significantly worse liver function tests (serum AST, albumin, bilirubin, INR). Liver function tests correlated with RI. In group A all patients died (n = 11) or underwent transplantation (n = 21) of whom 4 died, compared with only 2 of group B who died, and 4 who were transplanted without fatality. At 2 yrs there were no survivors in Group A without OLT, all deaths occurring within 13 months. In group B actuarial survival at 5 yrs was 92%. The difference between these groups was highly significant (p<0.0001). RI (p<0.0004) and INR (p<0.0003) were the only independent predictors of risk of dying, with RI≥1 increasing the risk of death fivefold. We suggest that regular ultrasound Doppler examination in patients with BA can detect a group with RI≥1.0 who have a high risk of early mortality, require early evaluation and listing for OLT. Patients with BA already listed for OLT require 2-3 monthly ultrasound examinations with immediate upgrading of those found to have RI of 1.0 or above. Recognition and treatment of these patients may reduce waiting list mortality and improve results.