{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T21:27:32Z","timestamp":1788643652377,"version":"build-2803163510"},"reference-count":24,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T00:00:00Z","timestamp":1712793600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Acute\u2010on\u2010chronic liver failure (ACLF) is associated with increased mortality and morbidity in patients with biliary atresia (BA). Data on impact of ACLF on postoperative outcomes, however, are sparse.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>We performed a retrospective analysis of patients with BA aged &lt;18\u2009years who underwent LT between 2011 and 2021 at our institution. ACLF was defined using the pediatric ACLF criteria: \u22651 extra\u2010hepatic organ failure in children with decompensated cirrhosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 107 patients (65% female; median age 14 [9\u201331] months) who received a LT, 13 (12%) had ACLF during the index admission prior to LT. Two (15%) had Grade 1; 4 (30%) had Grade 2; and 7 (55%) had Grade\u2009\u22653 ACLF. ACLF cohort was younger at time of listing (5 [4\u20138] vs. 9 [6\u201324] months; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and at LT (8 [8\u201311] vs. 16 [10\u201340] months, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) compared to no\u2010ACLF group. Intraoperatively, ACLF patients had higher blood loss (40 [20\u201353] vs. 10 [6\u201319] mL\/kg; <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001) and blood transfusion requirements (33 [21\u201369] vs. 18 [7\u201325] mL\/kg; <jats:italic>p<\/jats:italic>\u2009=\u2009.004). Postoperatively, they needed higher vasopressor support (31% vs. 10.6%; <jats:italic>p<\/jats:italic>\u2009=\u2009.04) and had higher total hospital length of stay (106 [45\u2013151] vs. 13 [7\u201330] days; <jats:italic>p<\/jats:italic>\u2009=\u2009.023). Rate of return to the operating room, hospital readmission rates, and 1\u2010year post\u2010LT survival rates were comparable between the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Despite higher perioperative complications, survival outcomes for ACLF in BA after LT are favorable and comparable to those without ACLF. These encouraging data reiterate prioritization during organ allocation of these critically ill children for LT.<\/jats:p><\/jats:sec>","DOI":"10.1111\/petr.14736","type":"journal-article","created":{"date-parts":[[2024,4,11]],"date-time":"2024-04-11T10:09:54Z","timestamp":1712830194000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Postoperative outcomes of acute\u2010on\u2010chronic liver failure in infants and children with biliary atresia"],"prefix":"10.1111","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7103-1299","authenticated-orcid":false,"given":"Buria","family":"Naeem","sequence":"first","affiliation":[{"name":"Section of Pediatric Critical Care Medicine, Department of Pediatrics Baylor College of Medicine  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adil","family":"Ayub","sequence":"additional","affiliation":[{"name":"Department of Surgery 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