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Updated: Jun 20, 2026
Laparoscopic Choledochal Cyst Excision and Roux-en-Y Choledochojejunostomy in Adults
Published on: February 28, 2025
The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study
Lorraine I Kelley-Quon1,2, Eveline Shue3, Rita V Burke4
1Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #100, Los Angeles, CA, 90027, USA. lkquon@chla.usc.edu.
Purpose:
The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia.
Methods:
A multi-institutional, retrospective cohort study was performed at nine tertiary-level children's hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance.
Results:
Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3 months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97-0.99).
Conclusion:
Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.
