{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T07:35:44Z","timestamp":1793000144185,"version":"4.5.0"},"reference-count":30,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Primary liver transplantation (PLT) remains a controversial alternative strategy for children with biliary atresia (BA). This national study of BA management in Italy over a 10\u2010year period aimed to better define the indications, limitations, and outcomes of PLT.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a retrospective, multicenter, observational study based on the Italian BA Registry, including 312 infants with BA managed in Italy between January 2012 and December 2021. All children who underwent PLT were selected for analysis. Children who underwent liver transplantation (LT) after Kasai portoenterostomy (KPE) failure were used as a comparison group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Primary liver transplantation was performed in 37 children with BA and established advanced liver disease; 181 other BA patients who underwent LT were selected for comparison. Minimum follow\u2010up was 3\u2009years for all patients. PLT infants were significantly older at diagnosis (13 were diagnosed after 120\u2009days of life). They had a significantly worse clinical condition both at diagnosis and at listing for transplantation. No child died before LT in the PLT group, whereas 5 patients died before LT in the early rescue\u2010LT group. Post\u2010transplant outcomes were comparable across groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Kasai portoenterostomy should remain the recommended first\u2010line treatment for most infants with BA, but its benefit is limited to only a proportion of patients. Some patients may be processed rapidly to LT because they present too late or with advanced disease: these patients have excellent outcomes as well.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70458","type":"journal-article","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:43:27Z","timestamp":1790405007000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Primary Liver Transplantation for Biliary Atresia: Another Piece of the Puzzle"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7681-6178","authenticated-orcid":false,"given":"Jean","family":"de Ville de Goyet","sequence":"first","affiliation":[{"name":"Paediatric Liver Unit ISMETT  Palermo Italy"},{"name":"UPMC Italy  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3341-5379","authenticated-orcid":false,"given":"Giovanni","family":"Boroni","sequence":"additional","affiliation":[{"name":"SCDU Chirurgia Pediatrica, ASST Spedali Civili di Brescia\u2014Ospedale Dei Bambini  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0311-5204","authenticated-orcid":false,"given":"Daniela","family":"Liccardo","sequence":"additional","affiliation":[{"name":"Division of Hepatology and Metabolic Diseases, Liver Transplant Unit Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4746-3489","authenticated-orcid":false,"given":"Daniele","family":"Alberti","sequence":"additional","affiliation":[{"name":"SCDU Chirurgia Pediatrica, ASST Spedali Civili di Brescia\u2014Ospedale Dei Bambini  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0796-6847","authenticated-orcid":false,"given":"Marco","family":"Spada","sequence":"additional","affiliation":[{"name":"Division of Hepatobiliopancreatic Surgery, Liver and Kidney Transplantation Bambino Ges\u00f9 Children's Hospital, IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3210-5491","authenticated-orcid":false,"given":"Valeria","family":"Casotti","sequence":"additional","affiliation":[{"name":"Paediatric Hepatology, Gastroenterology and Liver Transplant Unit Ospedale Papa Giovanni XIII  Bergamo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7483-234X","authenticated-orcid":false,"given":"Raffaele","family":"Iorio","sequence":"additional","affiliation":[{"name":"UOS Epatologia Pediatrica, Universit\u00e0 di Napoli Federico II  Napoli Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9264-3465","authenticated-orcid":false,"given":"Pier Luigi","family":"Calvo","sequence":"additional","affiliation":[{"name":"Gastroenterologia Pediatrica. Ospedale Infantile Regina Margherita, Azienda Ospedaliero\u2010Universitaria Citt\u00e0 Della Salute e Della Scienza di Torino  Turin Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicolo","family":"Rizzitello","sequence":"additional","affiliation":[{"name":"Statistics and Data Management Services, ISMETT  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5895-7257","authenticated-orcid":false,"given":"Giusy","family":"Ranucci","sequence":"additional","affiliation":[{"name":"Paediatric Liver Unit ISMETT  Palermo Italy"},{"name":"UPMC Italy  Palermo Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the Italian Society of Paediatric Gastroenterology, Hepatology, and Nutrition (SIGENP) AVB Network Working 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