Prognostic Factors for Native Liver Survival in Patients With Biliary Atresia After Kasai Portoenterostomy

Abstract

Purpose: The prognostic factors for native liver survival (NLS) of patients with biliary atresia (BA) after Kasai portoenterostomy were evaluated on the basis of our institutional experience.

Methods: Eighty-four patients with BA who underwent Kasai portoenterostomy from 1984 to 2017 were enrolled in this study. The patient characteristics, preoperative examination results, age at Kasai portoenterostomy, and initial dose of corticosteroids in patients with NLS (NLS group) and patients who died or underwent liver transplantation (non-NLS group) were analyzed.

Results: The NLS rates 1, 10, 20, and 25 years after surgery were 77.4%, 62.7%, 56.6%, and 46.9%, respectively. The mean ages at Kasai portoenterostomy (days) were 60.4 ± 16.3 in the NLS group and 73.1 ± 29.5 in the non-NLS group (p = 0.0135). The preoperative AST levels (IU/ l) were 180.1 ± 113.8 in the NLS group and 257.2 ± 231.4 in the non-NLS group (p = 0.0489). The preoperative serum total bilirubin levels (mg/dl) were 9.16 ± 3.65 in the NLS group and 12.77 ± 5.45 in the non-NLS group (p = 0.000489). The preoperative serum direct bilirubin levels were 6.27 ± 2.00 in the NLS group and 8.77 ± 4.15 in the non-NLS group (p = 0.000484). The initial doses of corticosteroids (mg/kg/day) were 3.49 ± 1.21 in the NLS group and 2.49 ± 1.73 in the non-NLS group (p = 0.00247).

Conclusions: In the present study of BA patients who were treated in our institution, the age at Kasai portoenterostomy, preoperative AST and serum bilirubin levels, and initial dose of corticosteroids were suggested to be useful prognostic factors for NLS.