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Prognostic factors for five-year survival in children with biliary atresia after the Kasai procedure

D U Nugraheni1, A T Sandewa1, Dennis1

  • 1Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Dr. Sardjito Hospital, Yogyakarta, Indonesia.

The Medical Journal of Malaysia
|December 26, 2025
PubMed

Insights

This study found no association between common factors like surgery timing or liver enzyme levels and 5-year survival in biliary atresia (BA) patients after the Kasai procedure. Further research is needed to identify reliable prognostic factors for BA patient outcomes.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Hepatology

Background:

  • Biliary atresia (BA) is a severe idiopathic neonatal liver disease causing progressive bile duct obstruction.
  • The Kasai procedure is the primary surgical intervention for BA, aiming to restore bile flow.
  • Identifying prognostic factors is crucial for improving long-term outcomes in BA patients.

Purpose of the Study:

  • To investigate potential prognostic factors influencing 5-year survival in pediatric patients with biliary atresia (BA).
  • To analyze the association of surgical timing, liver function tests (LFTs), and surgeon experience with survival post-Kasai procedure.

Main Methods:

  • Retrospective cohort study design.
  • Inclusion of BA patients who underwent the Kasai procedure between January 2012 and December 2018.
  • Statistical analysis to assess the correlation between various clinical parameters and 5-year survival.

Main Results:

  • No statistically significant association was found between age at surgery and 5-year survival (p=0.408).
  • Liver enzyme levels (AST, ALT) and total bilirubin at 7 days post-surgery, along with their ratios, did not predict survival.
  • Surgeon experience also showed no significant impact on 5-year survival outcomes (p=0.479).

Conclusions:

  • The study suggests that factors such as timing of surgery, early post-operative liver enzyme levels, and surgeon experience may not be reliable predictors of 5-year survival in BA patients.
  • Further large-scale cohort studies are recommended to validate these findings and identify definitive prognostic markers for biliary atresia.
Abstract

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