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Early Cholangitis after Portoenterostomy in Children with Biliary Atresia
Priya Ramachandran1,2, Mohamed Safwan2, Muthukrishnan Saravana Balaji1
1Department of Pediatric Surgery, CHILDS Trust Medical Research Foundation, Kanchi Kamakoti Childs Trust Hospital, Chennai, Tamil Nadu, India.
Insights
Cholangitis is common after Kasai portoenterostomy for biliary atresia, especially in children who clear jaundice. Early cholangitis impacts native liver survival, with a 33% 1-year survival rate in affected infants.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia (BA) is a serious liver disease in infants.
- Kasai portoenterostomy (PE) is the primary surgical treatment for BA.
- Post-operative cholangitis is a known complication following PE.
Purpose of the Study:
- To investigate the impact of early cholangitis on jaundice clearance after PE.
- To determine the effect of cholangitis on 1-year native liver survival (NLS) in BA patients.
Main Methods:
- Retrospective analysis of a prospectively maintained database of BA patients.
- Characterization of cholangitis episodes (frequency, nature) post-PE.
- Calculation of jaundice clearance and 1-year NLS rates.
Main Results:
- 27 out of 62 children (43.5%) developed cholangitis within 14 months of PE.
- Cholangitis was more frequent in children who achieved jaundice clearance.
- Nine children with cholangitis survived with their native liver for over 1 year.
- Three out of 12 children with intractable cholangitis survived with their native liver at 1 year.
Conclusions:
- Cholangitis is a frequent occurrence in BA patients who clear jaundice post-PE.
- The 1-year native liver survival rate for children experiencing cholangitis after PE was 33%.
Aims And Objectives:
Biliary atresia (BA) is a cholangiodestructive disease of the biliary tree. The first line of treatment is a Kasai portoenterostomy (PE) following which patients may develop cholangitis. We studied the effect of early cholangitis on the outcome of PE, namely jaundice clearance and early native liver survival (NLS).
Methods:
We reviewed the data of all children who developed cholangitis after PE from our prospectively maintained database of children with BA. The standardized treatment of all children in the database is described. The frequency and nature of these episodes were characterized, and the outcome of PE and NLS 1 year after PE was calculated.
Results:
Of 62 children who underwent PE in our institutions, 27 developed cholangitis. All episodes of cholangitis occurred within 14 months of PE. Of 25 children who cleared jaundice in the overall series, 19 had cholangitis. The incidence of cholangitis was significantly higher in children who cleared jaundice. Nine children who had cholangitis are alive with native livers for more than 1 year after PE. Twelve children had intractable cholangitis. Three of these children are alive with native liver 1 year after PE.
Conclusion:
In our series, cholangitis occurred in most children who cleared jaundice. Furthermore, the 1-year NLS of children who developed cholangitis was 33%.
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