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Prognostic Outcomes by Ishak Fibrosis Score Grouping in Biliary Atresia After Kasai Surgery
Lu Huang1,2, Yong-Xing Hao1,2, Cheng-Yan Tang1,2
1Pediatric Surgery Department, Affiliated Hospital of Zunyi Medical University, Zunyi City, Guizhou Province, People's Republic of China.
Objective:
This study aimed to assess the native liver survival (NLS) of biliary atresia (BA) patients with varying Ishak scores post Kasai portoenterostomy (KPE).
Methods:
A prospective cohort study analyzed 83 BA patients who underwent KPE. Patients were stratified into Mild Fibrosis Group (Ishak 1-2, n=20), Moderate Fibrosis Group (Ishak 3-4, n=39), and Cirrhosis Group (Ishak 5-6, n=24) based on postoperative Ishak scores. At the 6-month postoperative follow-up, clinical characteristics and liver function test outcomes were compared between groups to evaluate postoperative recovery profiles.
Results:
Generalized estimating equations (GEE) revealed time-dependent declines in ALT, AST, ALP, and Total Bile Acid (TBA) across groups (P<0.05), with cirrhosis patients exhibiting higher GGT and bilirubin levels vs. mild fibrosis (P<0.05). 6-month Clearance of Jaundice (CoJ) differed significantly: 55.0% (mild) vs. 38.5% (moderate) vs. 8.3% (cirrhosis) (P=0.003). Six-month NLS sharply declined with fibrosis severity: 80.0% (mild) vs. 16.7% (cirrhosis) (P<0.001). Multivariate logistic regression identified lower Ishak scores and younger surgical age as independent predictors of survival (P<0.05).
Conclusion:
KPE improved liver function, but the Cirrhosis Group had poorer outcomes. Hepatic fibrosis severity correlated negatively with NLS, highlighting the importance of early surgery.
