Predicting the outcomes of Kasai portoenterostomy for biliary atresia: a cohort study

ObjectivesTo identify factors associated with outcomes of Kasai portoenterostomy (KPE), and predictors of 2- and 5- year native liver survival (NLS) for infants achieved jaundice clearance (JC) within 6 months of KPE. MethodsThis retrospective cohort study was conducted on 151 patients with type III biliary atresia (BA) who underwent KPE at our center. Univariate analysis and logistic regression analyses were performed to identify factors associated with NLS in infants achieved JC. Kaplan-Meier curves and log-rank tests were used to estimate the NLS, and the Cox proportional hazards regression model identified variables most associated with 2- and 5-year NLS at 6 months post-KPE. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of these factors. ResultsThe 2- and 5-year NLS of infants achieved JC at 3 months post-KPE were not different from those achieved JC earlier. Operation age and total bile acid (TBA) were factors associated with JC. For infants who have achieved JC, DB was the only factor associated with 2-year NLS, the AUC was 0.872, the cutoff value was 14 mol/L; ALB and DB were factors associated with 5-year NLS, the AUCs were 0.894 and 0.95, and the cutoff values were 39 g/L and 14 mol/L, respectively. ConclusionsNLS should be estimated at 6 months post-KPE. Preoperative factors are not predictive of NLS. For infants cleared jaundice, DB and ALB can predict NLS with good performance. Whats Known on This SubjectAge, liver stiffness, and CMV infections are factors associated with outcomes of Kasai portoenterostomy. Jaundice clearance is directly associated with native liver survival; however, even with successful surgery, liver pathology in most cases will progress to end-stage cirrhosis. What This Study AddsNo preoperative factors are predictive of native liver survival (NLS). Infants cleared jaundice after 3 months of KPE can achieve the same NLS as those cleared jaundice earlier. For infants cleared jaundice, 6-month postoperative DB and Albumin are predictive of NLS. How this study might affect research, practice or policyIn this study, we argued that 6 months post-KPE was the appropriate timing for predicting NLS; direct bilirubin (DB) and albumin (ALB) at 6 months post-KPE can be used to predict 2- and 5-year NLS with good performance. Article SummaryRetrospective analysis revealed its difficult to predict outcomes of Kasai portoenterostomy (KPE) preoperatively; jaundice clearance should be evaluated at 6 months after KPE, for infants cleared jaundice, 6-month postoperative DB and Albumin are predictive of NLS.