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Technique of Porcine Liver Procurement and Orthotopic Transplantation using an Active Porto-Caval Shunt
Published on: May 7, 2015
Outcome of early hepatic portoenterostomy for biliary atresia
D Volpert1, F White, M J Finegold
1Department of Pediatrics, Washington University School of Medicine, St Louis Children's Hospital, Missouri 63110, USA.
Insights
Performing the Kasai procedure before 30 days of age for biliary atresia may lead to worse outcomes. Early intervention for biliary atresia requires further investigation into disease pathogenesis.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Hepatic portoenterostomy (Kasai procedure) outcomes for biliary atresia improve with surgery before 90 days of age.
- The comparative effectiveness of intervention before versus after 30 days of age remains unclear.
Purpose of the Study:
- To compare the outcomes of the Kasai procedure for biliary atresia performed before 30 days of age versus after 30 days of age.
Main Methods:
- Retrospective review of patient records from 1984-1999 at St. Louis Children's Hospital.
- Analysis of outcomes for patients undergoing the Kasai procedure before or after 30 days of age.
Main Results:
- Of 92 patients, 9 had the Kasai procedure before 30 days; 77.8% required liver transplantation at a mean age of 11.0 months.
- Patients undergoing the procedure after 30 days (n=83) had a 53.4% liver transplantation rate at a mean age of 32.14 months.
Conclusions:
- Outcomes appear worse for Kasai procedures performed before 30 days of age.
- This finding may suggest differences in biliary atresia pathogenesis or earlier clinical presentation.
- Biliary atresia may represent a phenotype for distinct underlying diseases.
Background:
The outcome of the hepatic portoenterostomy (Kasai) procedure for biliary atresia is improved when it is performed before 90 days of age. However, it is not known whether intervention before 30 days is better than intervention between 30 and 90 days.
Methods:
The authors reviewed the records of all patients seen by the Pediatric Gastroenterology Service at St. Louis Children's Hospital from 1984-1999 to ascertain the outcome of patients who underwent Kasai procedure before or after 30 days of age.
Results:
Of 92 patients with biliary atresia treated at St. Louis Children's Hospital over 15 years, 9 underwent the Kasai procedure before 30 days of age. Liver transplantation was necessary in 77.8% of these patients at a mean age of 11.0 +/- 4.26 months, as compared with 53.4% at 32.14 +/- 7.14 months for the remainder of the patients who underwent the procedure after 30 days of age.
Conclusions:
Although these data suggest that outcomes are worse for patients who undergo the procedure before 30 days of age, they may reflect a difference in the pathogenesis of biliary atresia that brings it to clinical attention earlier and may provide further evidence that biliary atresia is a phenotype for a number of distinct underlying disease processes.
