Surgical outcomes in Alagille syndrome and PFIC: A single institution's 20-year experience

Background

Alagille Syndrome (AGS) and Progressive Familial Intrahepatic Cholestasis (PFIC) are rare pediatric biliary disorders that lead to progressive liver disease. This study reviews our experience with the surgical management of these disorders over the last 20 years.

Methods

We retrospectively reviewed the records of children diagnosed with AGS or PFIC from January 1996 to December 2016. Data collected included demographics, surgical intervention (liver transplant or biliary diversion), and complications.

Results

Of 37 patients identified with these disorders, 17 patients (8 AGS,9 PFIC) underwent surgical intervention. Mean postsurgical follow-up was 6.9 ± 4.7 years. Liver transplantation was the most common procedure (n = 14). Two patients who were initially thought to have biliary atresia underwent hepatoportoenterostomy, but were subsequently shown to have Alagille syndrome. Biliary diversion procedures were performed in 3 patients (external n = 1, internal n = 2). PFIC patients tended to be older at the time of liver transplant compared to AGS (4.3 ± 3.9 years vs. 2.4 ± 1.1 years, p = 0.25). The AGS patient with external diversion had resolution of symptoms and no complications (follow-up: 12.5 years). Both PFIC patients with internal diversion (conduit between gallbladder and transverse colon) had resolution of pruritus and no progression of liver disease (follow-up: 3.8 and 4.5 years).

Conclusions

AGS and PFIC are rare biliary disorders in children which result in pruritus and progressive liver failure. Three patients in this series (8%) benefited from biliary diversion for control of pruritus and have not to date required transplantation for progressive liver disease. 38% underwent transplantation owing to pruritus and severe liver dysfunction.

Level of Evidence

2b