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Early surgical outcomes and pathological scoring values of older infants (≥ 90 d old) with biliary atresia
Gong Chen1, Shan Zheng, Song Sun
1Surgical Department, Children's Hospital of Fudan University, Shanghai 201102, China. chengongzlp@hotmail.com
Insights
Older infants (≥ 90 days) with biliary atresia (BA) can still benefit from the Kasai procedure, with pathological scoring not predicting jaundice clearance in this group. This finding impacts surgical timing and management strategies for BA.
Area of Science:
- Pediatric surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia (BA) is a severe neonatal liver disease requiring prompt surgical intervention.
- The Kasai procedure is the standard surgical treatment for BA, aiming to restore bile flow.
- Optimal timing for the Kasai procedure remains a critical factor influencing outcomes.
Purpose of the Study:
- To evaluate the impact of age at Kasai operation on short-term outcomes in type III biliary atresia.
- To determine if pathological scoring can predict the efficacy of the Kasai procedure in infants older than 90 days.
Main Methods:
- Retrospective analysis of 452 infants with type III BA (2004-2010).
- Assessment of jaundice clearance and 2-year native liver survival rates based on age at Kasai operation.
- Histological scoring of pathological slides.
Main Results:
- Infants aged ≤60 days had the worst initial jaundice clearance, while those ≥90 days did not show significantly different clearance rates at 3 or 6 months.
- Pathological scores did not predict jaundice clearance in infants ≥90 days old.
- Two-year native liver survival in infants ≥90 days was 36.1%.
Conclusions:
- The Kasai procedure can benefit some infants with type III BA even when performed after 90 days of age.
- Pathological scoring is not a reliable predictor of jaundice clearance in older infants undergoing the Kasai procedure.
- These findings suggest that surgical intervention for BA should not be solely dictated by age, and older infants may still achieve positive outcomes.
Purpose:
This study aimed to analyze the impact of age at Kasai operation on the short-term outcome of type III biliary atresia (BA) and to discuss if pathological scoring can be the prediction of effect in the Kasai procedure for the older (≥ 90 days) infant.
Methods:
During the period 2004 through 2010, 452 infants with type III BA were reviewed. The relationship between ages at Kasai operation and jaundice clearance rates and two year native liver survival rates were assessed, retrospectively. Pathological slides were analyzed with a histological scoring system.
Results:
All of the patients were divided into 3 groups according to their ages at operation (group A: aged 60 days or less (n=146), group B: age between 60 and 90 days (n=222) , and group C: age on or over 90 days (n=84)). The worst outcome of clearance of jaundice was found in group A but not in group C 2 weeks after the operation (P<0.05). Jaundice clearance rates showed no difference among the three groups either at 3-months or 6-months after operation. Moreover, in group C patients, the pathological scores showed no difference between the jaundice clearance group and jaundice persistence group 6 months after surgery. In group C, two year survival rate of patients with native livers was 36.1%.
Conclusion:
Some patients over 90 days of age at surgery can still benefit from a Kasai procedure. The pathological scoring system does not play a role in predicting jaundice clearance in patients over 90 days of age at surgery.