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Combined Predictors of Long-Term Outcomes of Kasai Surgery in Infants with Biliary Atresia
Anna Degtyareva1,2, Medan Isaeva3, Elena Tumanova4
1Department of Pediatric, Kulakov National Medical Research Center for Obstetrics, Gynecology and Perinatology, Moscow, Russia.
Insights
Predicting Kasai procedure success in biliary atresia (BA) is crucial. Early postoperative blood cholesterol, direct bilirubin, and Desmet score can predict surgical efficacy in infants with BA.
Area of Science:
- Pediatric Surgery
- Neonatal Hepatology
- Medical Predictive Modeling
Background:
- Biliary atresia (BA) is the primary cause of neonatal cholestasis, affecting 25-45% of cases.
- The Kasai procedure (hepatic portoenterostomy) is the standard treatment, but long-term efficacy is limited to 20-40% of infants.
- Developing accurate predictive models for surgical outcomes is essential for patient management.
Purpose of the Study:
- To develop a predictive model for the efficacy of the Kasai procedure in infants with biliary atresia.
- To identify reliable preoperative and early postoperative indicators of surgical success.
- To improve upon existing prognostic thresholds for predicting long-term outcomes.
Main Methods:
- A cohort of 166 infants with BA who underwent the Kasai procedure was analyzed.
- Infants were categorized into favorable and adverse outcome groups based on surgical success.
- Over 40 parameters were assessed, including preoperative and early postoperative laboratory values and liver biopsy findings (Desmet score).
Main Results:
- The Kasai procedure was efficacious in 42% (69/166) and non-efficacious in 58% (97/166) of the infants.
- A predictive model was developed that assesses efficacy by postoperative day 14, outperforming the traditional 3-6 month direct bilirubin threshold.
- Inclusion of the Desmet fibrosis score significantly refined the predictive model's accuracy.
Conclusions:
- Early postoperative indicators, specifically blood cholesterol <5.41 mmol/L and direct bilirubin <56.3 µmol/L on days 14±3, predict efficacious Kasai surgery.
- A low Desmet fibrosis score further enhances the prediction of successful surgical outcomes in infants with BA.
- This model offers an earlier and more refined assessment of Kasai procedure efficacy, aiding clinical decision-making.
Purpose:
Biliary atresia (BA) is the leading cause of neonatal cholestasis (25-45%). The primary treatment is hepatic portoenterostomy (Kasai procedure), but only 20-40% provide long-term benefits. This study aimed to develop a predictive model for surgical efficacy by comparing preoperative and early postoperative indicators in infants with different outcomes.
Methods:
We enrolled 166 infants with BA (93 girls, 73 boys) who underwent the Kasai procedure between September 2002 and December 2021, dividing them into favorable or adverse outcome groups. Over 40 parameters were measured, and the diagnostic significance of the prognostic model was evaluated.
Results:
Kasai surgery was efficacious in 69 patients (42%) and non-efficacious in 97 (58%). Our model assesses efficacy by day 14 after surgery, improving on the <34 µmol/L direct bilirubin threshold established for 3-6 months after the procedure. Including the Desmet fibrosis score refined the model.
Conclusion:
Blood cholesterol below 5.41 mmol/L, direct bilirubin below 56.3 µmol/L on postoperative days 14±3, and a low Desmet score indicate a high probability of efficacious Kasai surgery in infants with BA.
