Postoperative course and indications for liver transplantation in biliary atresia: 20 years of experience in our hospital

Abstract

Undergoing a Kasai portoenterostomy (KP) to enable the clearing of jaundice (COJ) is the only way for patients with biliary atresia (BA) to achieve native liver survival (NLS). However, COJ does not always guarantee NLS. We retrospectively reviewed the clinical course and indications for liver transplantation (LT) of BA cases in our hospital. We reviewed the clinical course of patients who underwent KP for BA at our hospital from January 2003 to June 2022 and who were followed up until December 2022. In all, we reviewed 129 cases of which 32 failed to achieve COJ, and 31 underwent LT. COJ was achieved in 97 cases. The median time to the first KP was 58 days, which was significantly earlier than the median time of 69 days of the cases who failed COJ. Of the 97 cases who achieved COJ, 25 required LT. The indications for LT included recurrent jaundice (9 cases), cholangitis (8 cases), gastrointestinal bleeding (4 cases), hepatopulmonary syndrome (3 cases), and the other (1 case). Of all cases reviewed, 55% of cases were able to live with their native liver, and 26% of cases who achieved COJ required LT.