What Makes A "Successful" Kasai Portoenterostomy "Unsuccessful"?

Area of Science:

• Pediatric Surgery
• Hepatology
• Gastroenterology

Background:

• Clearance of jaundice (CoJ) following Kasai portoenterostomy (KPE) is the primary goal for biliary atresia (BA).
• Achieving CoJ is the strongest predictor of long-term prognosis in BA patients.
• Identifying factors leading to subsequent liver transplant (LT) is essential for improving patient outcomes.

Purpose of the Study:

• To investigate the reasons for failure (requiring LT) in infants who underwent KPE for BA.
• To identify predictive factors for LT at 3 months post-KPE.

Main Methods:

• A prospective database of BA patients undergoing KPE was reviewed.
• Successful KPE was defined as postoperative bilirubin ≤20 µmol/L.
• Multivariate logistic regression identified predictors of LT by 2 years post-KPE.

Main Results:

• Of 135 infants, 90 (67%) achieved CoJ; 20 (22%) of these later required LT.
• Recurrent cholangitis and portal hypertension (gastrointestinal bleeding) were significantly more frequent in the LT group.
• High APRi, bilirubin, INR, and ascites at 3 months post-KPE predicted LT with high accuracy (AUROC = 0.98).

Conclusions:

• Failure of KPE leading to LT is not determined at the time of surgery.
• Recurrent cholangitis and symptomatic portal hypertension are the main drivers of LT in BA patients post-KPE.