Liver transplantation and the Kasai operation in biliary atresia

To assess the respective morbidity of the Kasai operation and liver transplantation in treating biliary atresia from the perspective of the referring institution, we analyzed the clinical course of 43 consecutive patients hospitalized at our institution from October 1980 to December 1985. Morbidity was arbitrarily defined as complications that required hospitalization, cholangitis, rejection, and was calculated by dividing the actual days hospitalized by the days "at risk." Morbidity assigned to transplantation also included pretransplant hospitalizations necessitated for life-sustaining treatment after referral. The morbidity in 40 patients who were treated by the Kasai procedure was 16.1%, which could be broken down to 50.6% in those who died after operation, 17.4% in those patients subsequently referred for transplantation, and 10.2% in the 16 patients successfully treated. Thirteen of the latter have perfect or near perfect liver function and are in excellent health. The morbidity of the 17 patients who were referred for liver transplantation, including two referred immediately after initial exploration, was 16.0%, which could be broken down to 10.4% before transplantation and 49.8% afterwards. Seven patients died awaiting transplantation, all but one of whom were referred during the first year of life. The average time spent on the waiting list was 203 days. Biliary atresia remains a disease of high morbidity regardless of treatment. Continued hospitalizations are necessary for ongoing Kasai management and life-sustaining treatment following transplant referral. The time spent on transplant waiting lists is protracted, and many patients die before obtaining a new liver.(ABSTRACT TRUNCATED AT 250 WORDS)