Ratio of Preoperative and Postoperative Serum Bilirubin Levels Predicts Early Outcome Following Biliary Atresia Surgery

Overview

Journal J Indian Assoc Pediatr Surg

Specialty Pediatrics

Date 2018 Apr 24

PMID 29681698

Citations 1

Authors

Kashish Khanna

Veereshwar Bhatnagar

Sandeep Agarwala

Maddur Srinivas

Siddhartha Datta Gupta

Affiliations

Soon will be listed here.

Abstract

Aim: This study investigates the fall in total serum bilirubin levels within 1 week after surgery, as a marker to predict early outcome in biliary atresia (BA) patients post-Kasai portoenterostomy (KP).

Methods: The ratio of total serum bilirubin levels at the 7 postoperative day to the preoperative level (TB7/TB0) in patients undergoing KP was calculated (January 2011-July 2015). Patients were stratified after 3-months follow-up into outcome groups depending on the clinical clearance of jaundice and TB7/TB0 ratio was correlated to outcome and liver histopathological changes in these groups.

Results: Sixty-one patients (M:F = 44:17), median age 75 days were included. At the end of 3 months, 27 (44.39%) were anicteric while 26 (42.6%) were still clinically jaundiced. Patients with a higher median value of TB7/TB0, that is, 0.856 were more likely to have jaundice at the end of 3 months as compared to patients with a lower median value of 0.615 ( < 0.0001). A cutoff TB7/TB0 ratio >0.723 predicted the KP outcome with 84.6% sensitivity and 81.5% specificity. The difference in TB7/TB0 ratio between patients with varying severity of liver histopathological changes was also significant, namely, cholestasis ( = 0.01), hepatocellular damage ( = 0.03), portal inflammation ( = 0.04), and portal fibrosis ( = 0.02).

Conclusions: The rapidity of fall in the total serum bilirubin levels within 1 week post-KP was able to predict the likely outcome in BA patients.

Citing Articles

Combined Predictors of Long-Term Outcomes of Kasai Surgery in Infants with Biliary Atresia.

Degtyareva A, Isaeva M, Tumanova E, Filippova E, Sugak A, Razumovsky A Pediatr Gastroenterol Hepatol Nutr. 2024; 27(4):224-235.

PMID: 39035404 PMC: 11254651. DOI: 10.5223/pghn.2024.27.4.224.

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

Endo M, Masuyama H, Watanabe K, Hagane K, Ikawa H, Yokoyama J . Calculation of biliary atresia prognostic index using a multivariate linear model. J Pediatr Surg. 1995; 30(11):1575-9. DOI: 10.1016/0022-3468(95)90160-4. View

Karrer F, Lilly J, Stewart B, Hall R . Biliary atresia registry, 1976 to 1989. J Pediatr Surg. 1990; 25(10):1076-80; discussion 1081. DOI: 10.1016/0022-3468(90)90222-u. 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

Starzl T, Esquivel C, Gordon R, Todo S . Pediatric liver transplantation. Transplant Proc. 1987; 19(4):3230-5. PMC: 2903879. View

Baruah R, Bhatnagar V, Agarwala S, Gupta S . Correlation of pre- and post-operative liver function, duct diameter at porta hepatis, and portal fibrosis with surgical outcomes in biliary atresia. J Indian Assoc Pediatr Surg. 2015; 20(4):184-8. PMC: 4586981. DOI: 10.4103/0971-9261.161040. View

Kasai M, Watanabe I, Ohi R . Follow-up studies of long term survivors after hepatic portoenterostomy for "noncorrectible" biliary atresia. J Pediatr Surg. 1975; 10(2):173-82. DOI: 10.1016/0022-3468(75)90275-4. View

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

10.

Miyano T, Fujimoto T, Ohya T, Shimomura H . Current concept of the treatment of biliary atresia. World J Surg. 1993; 17(3):332-6. DOI: 10.1007/BF01658700. View

11.

Yanchar N, Shapiro A, Sigalet D . Is early response to portoenterostomy predictive of long-term outcome for patients with biliary atresia?. J Pediatr Surg. 1996; 31(6):774-8. DOI: 10.1016/s0022-3468(96)90130-x. View

12.

Sharma S, Das P, Dattagupta S, Kumar L, Gupta D . Liver and portal histopathological correlation with age and survival in extra hepatic biliary atresia. Pediatr Surg Int. 2011; 27(5):451-61. DOI: 10.1007/s00383-010-2845-5. View

13.

Davenport M, Caponcelli E, Livesey E, Hadzic N, Howard E . Surgical outcome in biliary atresia: etiology affects the influence of age at surgery. Ann Surg. 2008; 247(4):694-8. DOI: 10.1097/SLA.0b013e3181638627. View

14.

McKiernan P, Baker A, Kelly D . The frequency and outcome of biliary atresia in the UK and Ireland. Lancet. 2000; 355(9197):25-9. DOI: 10.1016/S0140-6736(99)03492-3. View

15.

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

16.

Gupta L, Gupta S, Bhatnagar V . Extrahepatic biliary atresia: Correlation of histopathology and liver function tests with surgical outcomes. J Indian Assoc Pediatr Surg. 2012; 17(4):147-52. PMC: 3518991. DOI: 10.4103/0971-9261.102326. View

17.

Maksoud J, Fauza D, Silva M, Porta G, Miura I, Zerbini C . Management of biliary atresia in the liver transplantation era: a 15-year, single-center experience. J Pediatr Surg. 1998; 33(1):115-8. DOI: 10.1016/s0022-3468(98)90375-x. View

18.

Altman R . The portoenterostomy procedure for biliary atresia: a five year experience. Ann Surg. 1978; 188(3):351-62. PMC: 1396983. DOI: 10.1097/00000658-197809000-00010. View