The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

Purpose The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia. Methods A multi-institutional, retrospective cohort study was performed at nine tertiary-level children’s hospitals in the United States. Infants who underwent Kasai po...

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Published in:Pediatric surgery international Vol. 38; no. 2; pp. 193 - 199
Main Authors: Kelley-Quon, Lorraine I., Shue, Eveline, Burke, Rita V., Smith, Caitlin, Kling, Karen, Mahdi, Elaa, Ourshalimian, Shadassa, Fenlon, Michael, Dellinger, Matthew, Shew, Stephen B., Lee, Justin, Padilla, Benjamin, Inge, Thomas, Roach, Jonathan, Marwan, Ahmed I., Russell, Katie W., Ignacio, Romeo, Fialkowski, Elizabeth, Nijagal, Amar, Im, Cecilia, Azarow, Kenneth S., Ostlie, Daniel J., Wang, Kasper
Format: Journal Article
Language:English
Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.02.2022
Springer Nature B.V
Subjects:
Age
Biliary Atresia - surgery
Cholangitis
Consortia
Health Insurance Portability & Accountability Act 1996-US
Hospitals
Humans
Infant
Liver Transplantation
Liver transplants
Medical prognosis
Medicine
Medicine & Public Health
Mortality
Original Article
Pediatric Surgery
Pediatrics
Portoenterostomy, Hepatic
Retrospective Studies
Steroids
Surgery
Thoracic surgery
Treatment Outcome
Variables
Liver transplant
Kasai portoenterostomy
Biliary atresia
Transplant-free survival
ISSN:0179-0358, 1437-9813, 1437-9813
Online Access:Get full text
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Summary:Purpose The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia. Methods A multi-institutional, retrospective cohort study was performed at nine tertiary-level children’s hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance. Results Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3 months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97–0.99). Conclusion Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.
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Author Contributions: All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Lorraine Kelley-Quon, Rita Burke, Elaa Mahdi, and Shadassa Ourshalimian. The first draft of the manuscript was written by Lorraine Kelley-Quon and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.
ISSN:0179-0358
1437-9813
1437-9813
DOI:10.1007/s00383-021-05047-1