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Relevant factors for early liver transplantation after Kasai portoenterostomy
Liang Ge1, Jianghua Zhan2, Wei Gao3
1Graduate School of Tianjin Medical University, Tianjin, 300070, China.
Insights
Jaundice clearance after Kasai portoenterostomy (KP) is crucial for native liver survival (NLS) in children with biliary atresia. Delayed KP surgery and early cholangitis negatively impact NLS and are linked to early liver transplantation.
Area of Science:
- Pediatric Surgery
- Hepatology
- Gastroenterology
Background:
- Biliary atresia is a leading indication for pediatric liver transplantation.
- Kasai portoenterostomy (KP) is a palliative surgical procedure to improve bile flow.
- Early liver transplantation (LT) is often necessary for children with biliary atresia who fail KP.
Purpose of the Study:
- To identify factors influencing the need for early liver transplantation (LT) following Kasai portoenterostomy (KP) in children with biliary atresia.
- To analyze the relationship between pre-transplant clinical parameters and outcomes.
Main Methods:
- Retrospective analysis of 200 children with biliary atresia undergoing LT after KP.
- Patients categorized into three groups based on the interval between KP and LT (≤6 months, 6 months–2 years, >2 years).
- Comparison of factors including age at KP, jaundice clearance, cholangitis incidence, and liver function indexes.
Main Results:
- Younger age at KP (≤90 days) and successful jaundice clearance after KP were associated with better native liver survival (NLS).
- Early cholangitis and uncleared jaundice post-KP were significant risk factors for reduced NLS and were linked to earlier LT.
- Incidence of cholangitis varied significantly across groups based on KP-LT interval.
Conclusions:
- Factors such as older age at KP (>90 days), persistent jaundice, and early cholangitis after KP are associated with reduced NLS.
- Uncleared jaundice post-KP is a critical risk factor predicting the need for early liver transplantation.
- Optimizing KP timing and managing post-operative complications are vital for improving outcomes in biliary atresia.
Background:
To explore the relevant factors for early liver transplantation (LT) after Kasai portoenterostomy (KP).
Methods:
Retrospective analysis was performed for 200 children with biliary atresia, who underwent LT with hepatic failure after KP. According to the interval between KP and LT, they were divided into three groups: G1 (≤6-month), G2 (6-month~ 2-year) and G3 (> 2-year). Gender, age of Kasai portoenterostomy, jaundice-clearance, cholangitis after KP and liver function indexes before LT were compared among the three groups.
Results:
The proportion of patients with age of KP (≤90-day) in G1 was lower than that in G3 (P = 0.003). Jaundice-clearance occurred in 6 (7.6%), 26(28.6%) and 26 (86.7%) patients after KP in G1, G2 and G3 respectively (P < 0.001). There were statistical differences in the incidence of early cholangitis, late cholangitis and repeated cholangitis among the three groups (P = 0.035, < 0.001 and 0.022). The native liver survival (NLS) rate of children at operation age > 90-day was lower than that of children at operation age ≤ 90-day (P = 0.002). The NLS rate of the children with jaundice-clearance after KP was significantly better than that of the children without jaundice-clearance (P < 0.001). The NLS rate of the children with early cholangitis after operation was lower than that in children without early cholangitis (P = 0.026). The NLS rate of patients of G2 and G3 with cholangitis after KP was lower than that in children without cholangitis (P = 0.017). Multiple logistic regression analysis showed uncleared jaundice after KP was a risk factor for the NLS time in patients.
Conclusion:
The age of KP (> 90-day), jaundice-unclear and early cholangitis could reduce the NLS time after KP, which were related to early liver transplantation. Jaundice-unclear was a risk factor for early liver transplantation.
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