Kasai Procedure in Patients Older Than 90 Days: Worth a Cut

Area of Science:

• Pediatric Surgery
• Hepatology
• Gastroenterology

Background:

• Biliary atresia (BA) management often involves Kasai portoenterostomy (KPE), with age at surgery being crucial for native-liver survival.
• Improved pediatric liver transplantation (LT) outcomes raise questions about primary LT for late-presenting BA infants versus KPE.
• This study evaluates KPE outcomes in BA infants older than 90 days.

Purpose of the Study:

• To assess the efficacy of KPE in infants with biliary atresia diagnosed later than 90 days of age.
• To determine the impact of delayed KPE on native liver survival and the need for subsequent liver transplantation.
• To evaluate KPE as a primary treatment option for late-presenting BA.

Main Methods:

• Retrospective chart review of BA patients undergoing KPE between January 2010 and December 2020.
• Inclusion criteria: patients aged 90 days or older at the time of KPE.
• Data collected included patient characteristics, perioperative details, and follow-up outcomes.

Main Results:

• Eleven patients met the criteria, with a mean age of 108 days at KPE.
• Two-year jaundice clearance was achieved in 27% of patients.
• 73% of patients required liver transplantation, with a median of 626 days post-KPE; 36% transplanted within 1 year.
• Two deaths occurred due to disease-related complications; one patient maintained native liver function at 10 years old.

Conclusions:

• Kasai portoenterostomy (KPE) in older infants (≥90 days) with biliary atresia (BA) can prolong native liver survival.
• KPE serves as an effective bridge to liver transplantation (LT) for these patients.
• Delayed KPE remains a viable primary treatment option for late-presenting BA infants.