Does Time Taken to Achieve Jaundice-clearance Influence Survival of the Native Liver in Post-Kasai Biliary Atresia?

Overview

Journal World J Pediatr

Specialty Pediatrics

Date 2018 Mar 28

PMID 29582357

Citations 15

Authors

Hideaki Nakajima

Hiroyuki Koga

Manabu Okawada

Hiroki Nakamura

Geoffrey James Lane

Atsuyuki Yamataka

Affiliations

Soon will be listed here.

Abstract

Background: We reviewed the time taken for post-portoenterostomy (PE) biliary atresia (BA) patients to obtain jaundice-clearance (total bilirubin ≤ 1.2 mg/dL; JC) post-PE to determine if JC time (JCT) is prognostic for survival of the native liver (SNL).

Methods: The subjects were 66 BA patients treated with PE at our institute between 1989, the year when liver transplantation (LTx) became available in Japan, and 2014. JCT was used to create three groups (≤ 30 days: n = 14; 31-60 days: n = 31; ≥ 61 days: n = 21). Medical records were reviewed retrospectively to evaluate: age at onset of symptoms, duration of symptoms pre-PE, age and weight at PE, serum liver function tests, incidence of cholangitis, and micro-bile duct size at PE.

Results: Age at onset of symptoms, age and weight at PE, duration of symptoms pre-PE, and micro-bile duct size were similar for all patients in all three groups. JCT and SNL appeared to correlate because preoperative total bilirubin (7.1, 9.6, 10.2 mg/dL; P < 0.05) was significantly lower in the JCT ≤ 30 days group (P < 0.05) while there was a significant decrease in SNL (P < 0.03) and a significant increase in LTx (P < 0.01) in the JCT ≥ 61 days group. All LTx subjects who achieved JC were found to have developed cholangitis within 3 months of PE.

Conclusion: During the follow-up of post-PE subjects, longer JCT and cholangitis occurrence within 3 months of PE would appear to be negative prognostic factors for SNL while preoperative total bilirubin would appear to be a positive prognostic factor for SNL.

Citing Articles

Relationship between hepatic function recovery and postoperative cholangitis in neonates undergoing hepaticojejunostomy for biliary atresia.

Yan L, Yan L Am J Transl Res. 2024; 16(8):3822-3831.

PMID: 39262696 PMC: 11384408. DOI: 10.62347/CPFT4246.

A convenient nomogram for predicting early death or liver transplantation after the Kasai procedure in patients with biliary atresia.

Lu C, Xie H, Zhu Z, Ding Z, Geng Q, Tang W Langenbecks Arch Surg. 2024; 409(1):30.

PMID: 38189999 DOI: 10.1007/s00423-023-03216-5.

Native liver survivors of portoenterostomy for biliary atresia with excellent outcome: redefining "successful" portoenterostomy.

Tsuboi K, Watayo H, Tsukui T, Suda K, Abe E, Fujimoto T Pediatr Surg Int. 2022; 39(1):24.

PMID: 36454515 DOI: 10.1007/s00383-022-05313-w.

Relationship between the expression levels of CD4+ T cells, IL-6, IL-8 and IL-33 in the liver of biliary atresia and postoperative cholangitis, operative age and early jaundice clearance.

Zhang K, Chen Y, Zheng Z, Tang C, Zhu D, Xia X Pediatr Surg Int. 2022; 38(12):1939-1947.

PMID: 36242601 DOI: 10.1007/s00383-022-05258-0.

Adding a spur valve to laparoscopic portoenterostomy for patients with biliary atresia can achieve a high jaundice clearance rate and lower the number of episodes of cholangitis.

Yasui A, Hinoki A, Amano H, Shirota C, Tainaka T, Sumida W Pediatr Surg Int. 2022; 38(12):1881-1885.

PMID: 36104601 DOI: 10.1007/s00383-022-05230-y.

References

Goda T, Kawahara H, Kubota A, Hirano K, Umeda S, Tani G . The most reliable early predictors of outcome in patients with biliary atresia after Kasai's operation. J Pediatr Surg. 2013; 48(12):2373-7. DOI: 10.1016/j.jpedsurg.2013.08.009. View

Shneider B, Brown M, Haber B, Whitington P, Schwarz K, Squires R . A multicenter study of the outcome of biliary atresia in the United States, 1997 to 2000. J Pediatr. 2006; 148(4):467-474. DOI: 10.1016/j.jpeds.2005.12.054. View

Azarow K, Phillips M, Sandler A, Hagerstrand I, Superina R . Biliary atresia: should all patients undergo a portoenterostomy?. J Pediatr Surg. 1997; 32(2):168-72; discussion 172-4. DOI: 10.1016/s0022-3468(97)90173-1. View

Hartley J, Davenport M, Kelly D . Biliary atresia. Lancet. 2009; 374(9702):1704-13. DOI: 10.1016/S0140-6736(09)60946-6. View

Superina R, Magee J, Brandt M, Healey P, Tiao G, Ryckman F . The anatomic pattern of biliary atresia identified at time of Kasai hepatoportoenterostomy and early postoperative clearance of jaundice are significant predictors of transplant-free survival. Ann Surg. 2011; 254(4):577-85. PMC: 3460800. DOI: 10.1097/SLA.0b013e3182300950. View

Bu L, Chen H, Ni Y, Peng S, Jeng Y, Lai H . Multiple intrahepatic biliary cysts in children with biliary atresia. J Pediatr Surg. 2002; 37(8):1183-7. DOI: 10.1053/jpsu.2002.34468. View

Nio M, Ohi R, Miyano T, Saeki M, Shiraki K, Tanaka K . Five- and 10-year survival rates after surgery for biliary atresia: a report from the Japanese Biliary Atresia Registry. J Pediatr Surg. 2003; 38(7):997-1000. DOI: 10.1016/s0022-3468(03)00178-7. View

Nakamura H, Koga H, Wada M, Miyano G, Dizon R, Kato Y . Reappraising the portoenterostomy procedure according to sound physiologic/anatomic principles enhances postoperative jaundice clearance in biliary atresia. Pediatr Surg Int. 2011; 28(2):205-9. DOI: 10.1007/s00383-011-3019-9. View

Kubota A, Okada A, Fukui Y, Kawahara H, Imura K, Kamata S . Indocyanine green test is a reliable indicator of postoperative liver function in biliary atresia. J Pediatr Gastroenterol Nutr. 1993; 16(1):61-5. DOI: 10.1097/00005176-199301000-00012. View

10.

Lykavieris P, Chardot C, Sokhn M, Gauthier F, Valayer J, Bernard O . Outcome in adulthood of biliary atresia: a study of 63 patients who survived for over 20 years with their native liver. Hepatology. 2005; 41(2):366-71. DOI: 10.1002/hep.20547. View

11.

Oh M, Hobeldin M, Chen T, Thomas D, Atkinson J . The Kasai procedure in the treatment of biliary atresia. J Pediatr Surg. 1995; 30(7):1077-80; discussion 1080-1. DOI: 10.1016/0022-3468(95)90345-3. View

12.

Altman R, Lilly J, Greenfeld J, Weinberg A, Van Leeuwen K, Flanigan L . A multivariable risk factor analysis of the portoenterostomy (Kasai) procedure for biliary atresia: twenty-five years of experience from two centers. Ann Surg. 1997; 226(3):348-53; discussion 353-5. PMC: 1191037. DOI: 10.1097/00000658-199709000-00014. View

13.

Nio M, Wada M, Sasaki H, Tanaka H, Okamura A . Risk factors affecting late-presenting liver failure in adult patients with biliary atresia. J Pediatr Surg. 2012; 47(12):2179-83. DOI: 10.1016/j.jpedsurg.2012.09.003. View

14.

Ohhama Y, Shinkai M, Fujita S, Nishi T, Yamamoto H . Early prediction of long-term survival and the timing of liver transplantation after the Kasai operation. J Pediatr Surg. 2000; 35(7):1031-4. DOI: 10.1053/jpsu.2000.7765. View

15.

Howard E, MacLean G, Nio M, Donaldson N, Singer J, Ohi R . Survival patterns in biliary atresia and comparison of quality of life of long-term survivors in Japan and England. J Pediatr Surg. 2001; 36(6):892-7. DOI: 10.1053/jpsu.2001.23965. View

16.

Iwatsuki S, Shaw Jr B, Starzl T . Liver transplantation for biliary atresia. World J Surg. 1984; 8(1):51-6. PMC: 2978657. DOI: 10.1007/BF01658363. View

17.

Koga H, Wada M, Nakamura H, Miyano G, Okawada M, Lane G . Factors influencing jaundice-free survival with the native liver in post-portoenterostomy biliary atresia patients: results from a single institution. J Pediatr Surg. 2013; 48(12):2368-72. DOI: 10.1016/j.jpedsurg.2013.08.007. View

18.

Rodeck B, Becker A, Gratz K, Petersen C . Early predictors of success of Kasai operation in children with biliary atresia. Eur J Pediatr Surg. 2007; 17(5):308-12. DOI: 10.1055/s-2007-965518. View

19.

Hung P, Chen C, Chen W, Lai H, Hsu W, Lee P . Long-term prognosis of patients with biliary atresia: a 25 year summary. J Pediatr Gastroenterol Nutr. 2006; 42(2):190-5. DOI: 10.1097/01.mpg.0000189339.92891.64. View

20.

Shinkai M, Ohhama Y, Take H, Kitagawa N, Kudo H, Mochizuki K . Long-term outcome of children with biliary atresia who were not transplanted after the Kasai operation: >20-year experience at a children's hospital. J Pediatr Gastroenterol Nutr. 2009; 48(4):443-50. DOI: 10.1097/mpg.0b013e318189f2d5. View