Age Is Not a Criterion in Patient Selection for Kasai Portoenterostomy

Area of Science:

• Pediatric Surgery
• Hepatology
• Gastroenterology

Background:

• Biliary atresia (BA) is a severe neonatal liver disease requiring prompt surgical intervention.
• Kasai portoenterostomy (KPE) is the standard surgical procedure for BA, aiming to restore bile flow.
• The optimal timing for KPE remains a critical factor influencing outcomes.

Purpose of the Study:

• To compare the efficacy and safety of KPE in biliary atresia patients older than 90 days versus those younger than 90 days.
• To evaluate the outcomes of KPE specifically in the older pediatric group.

Main Methods:

• A retrospective analysis of a prospectively maintained database of BA patients who underwent KPE over 5 years.
• Patients were stratified into two groups: Group 1 (infants ≤90 days) and Group 2 (infants >90 days).
• Comparison of total and direct bilirubin levels, APRI scores, and surgical success rates (defined as direct bilirubin <2 mg/dl within 6 months).

Main Results:

• Seventeen patients were in the >90-day group (Group 2) and 45 in the ≤90-day group (Group 1).
• Group 2 showed a trend towards increased fibrosis (higher APRI, 47% Stage III histology vs. 22% in Group 1).
• KPE success was 29.4% in Group 2 versus 44% in Group 1; no significant differences in bilirubin levels or synthetic liver failure were observed between groups.

Conclusions:

• KPE can be safely performed in infants with biliary atresia older than 90 days.
• While success rates may be lower in older infants, age should not be an absolute contraindication for KPE, especially in the absence of synthetic liver failure.
• Further research may explore factors influencing KPE success in delayed presentations.