Preoperative risk factors for the early failure of the Kasai portoenterostomy in patients with biliary atresia

Capparelli, Mauro; Ayarzabal, Victor; Halac, Esteban; Questa, Horacio; Minetto, Maria Julia; Cervio, Guillermo; Barrenechea, Marcelo

doi:10.1007/s00383-021-04933-y

Cited by 5 publications

(4 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The major known factors for adverse outcomes in HPE are patient age at surgery (>3 months) and the syndromic forms of BA [ 11 ]. The outcomes have also revealed certain associations between biochemical markers [ 12 13 14 ] and histopathological indicators, including fibrosis [ 15 16 17 ], inflammation [ 18 ], and bile duct diameter [ 19 ]. The scope of the candidate predictors is limited, and the results obtained thus far require additional reflection and refinement.…”

Section: Introductionmentioning

confidence: 99%

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

Degtyareva,

Isaeva,

Tumanova

et al. 2024

Pediatr Gastroenterol Hepatol Nutr

View full text Add to dashboard Cite

Purpose Biliary atresia (BA) is the leading cause of neonatal cholestasis (25–45%). The primary treatment is hepatic portoenterostomy (Kasai procedure), but only 20–40% provide long-term benefits. This study aimed to develop a predictive model for surgical efficacy by comparing preoperative and early postoperative indicators in infants with different outcomes. Methods We enrolled 166 infants with BA (93 girls, 73 boys) who underwent the Kasai procedure between September 2002 and December 2021, dividing them into favorable or adverse outcome groups. Over 40 parameters were measured, and the diagnostic significance of the prognostic model was evaluated. Results Kasai surgery was efficacious in 69 patients (42%) and non-efficacious in 97 (58%). Our model assesses efficacy by day 14 after surgery, improving on the <34 µmol/L direct bilirubin threshold established for 3–6 months after the procedure. Including the Desmet fibrosis score refined the model. Conclusion Blood cholesterol below 5.41 mmol/L, direct bilirubin below 56.3 µmol/L on postoperative days 14±3, and a low Desmet score indicate a high probability of efficacious Kasai surgery in infants with BA.

show abstract

Section: Introductionmentioning

confidence: 99%

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

Degtyareva,

Isaeva,

Tumanova

et al. 2024

Pediatr Gastroenterol Hepatol Nutr

View full text Add to dashboard Cite

show abstract

“…12 However, that disease would deteriorate in most patients even after the KP and finally progress to hepatic decompensation, which requires frequent hospitalizations. [13][14][15] Liver transplantation (LT) has been another treatment option since 1967, and BA has gradually become the most common indication for LT in childhood. 16 Now, sequential treatment with an initial KP followed by LT for BA patients with end-stage liver disease has been the accepted standard therapy.…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors Related to In-hospital Death in Children with Biliary Atresia: Analysis of a Nationwide Inpatient Database

Shi¹,

Jiang²,

Zhou³

et al. 2022

J Clin Transl Hepatol

View full text Add to dashboard Cite

Background and Aims: Patients with biliary atresia (BA) are prone to hepatic decompensation, which might eventually lead to death. This study aimed to identify the possible risk factors affecting in-hospital death in BA patients in China. Methods: We collected data from the Hospital Quality Monitoring System, a national inpatient database. All patients aged up to 2 years old with a diagnosis of BA were included. The subjects were divided to three groups, including Kasai portoenterostomy (KP), liver transplantation (LT), and no surgery. Logistic regression with Firth's method was performed to identify potential influencing variables associated with in-hospital death. Results: During the year 2013 to 2017, there were 14,038 pediatric admissions with a diagnosis of BA. The proportion of in-hospital death in pediatric BA admissions was 1.08%. Compared with patients under six months, there was a higher risk of in-hospital death for children aged six months to 1 year and 1-2 years old. Clinical signs, including cirrhosis, variceal bleeding, and hepatic encephalopathy, were significantly associated with the risk of in-hospital death. In no surgery group, compared to those in Beijing and Shanghai, BA patients admitted in other districts had a lower risk of in-hospital death (OR=0.39, 95% CI: 0.21, 0.70). However, in the LT group, patients admitted in other districts had a higher risk of in-hospital death (OR=9.13, 95% CI: 3.99, 20.87). Conclusions: In-hospital survival remains unsatisfactory for pediatric BA patients with severe complications. Furthermore, more resources and training for BA treatment, especially LT, are essential for districts with poor medical care in the future.

show abstract

“…Histopathological parameters obtained during pre or peri-operative liver biopsy, including degree of liver fibrosis, can predict patients at risk for early failure of Kasai (i.e., the need for Ltx before one year of age or BA-related death) [ 12 ]. Moreover, bile duct proliferation, giant cells, and fibrosis have shown significant changes in fibrosis progression in BA over time [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis

Jahangirnia

Oltean

Nasr

et al. 2022

Pediatr Gastroenterol Hepatol Nutr

View full text Add to dashboard Cite

No systematic review to date has examined histopathological parameters in relation to native liver survival in children who undergo the Kasai operation for biliary atresia (BA). A systematic review and meta-analysis is presented, comparing the frequency of native liver survival in peri-operative severe vs. non-severe liver fibrosis cases, in addition to other reported histopathology parameters. Records were sourced from MEDLINE, Embase, and CENTRAL databases. Studies followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and compared native liver survival frequencies in pediatric patients with evidence of severe vs. non-severe liver fibrosis, bile duct proliferation, cholestasis, lobular inflammation, portal inflammation, and giant cell transformation on peri-operative biopsies. The primary outcome was the frequency of native liver survival. A random effects meta-analysis was used. Twenty-eight observational studies were included, 1,171 pediatric patients with BA of whom 631 survived with their native liver. Lower odds of native liver survival in the severe liver fibrosis vs. non-severe liver fibrosis groups were reported (odds ratio [OR], 0.16; 95% confidence interval [CI], 0.08–0.33; I 2 =46%). No difference in the odds of native liver survival in the severe bile duct destruction vs. non-severe bile duct destruction groups were reported (OR, 0.17; 95% CI, 0.00–63.63; I 2 =96%). Lower odds of native liver survival were documented in the severe cholestasis vs. non-severe cholestasis (OR, 0.10; 95% CI, 0.01–0.73; I 2 =80%) and severe lobular inflammation vs. non-severe lobular inflammation groups (OR, 0.02; 95% CI, 0.00–0.62; I 2 =69%). There was no difference in the odds of native liver survival in the severe portal inflammation vs. non-severe portal inflammation groups (OR, 0.03; 95% CI, 0.00–3.22; I 2 =86%) or between the severe giant cell transformation vs. non-severe giant cell transformation groups (OR, 0.15; 95% CI, 0.00–175.21; I 2 =94%). The meta-analysis loosely suggests that the presence of severe liver fibrosis, cholestasis, and lobular inflammation are associated with lower odds of native liver survival in pediatric patients after Kasai.

show abstract

Preoperative risk factors for the early failure of the Kasai portoenterostomy in patients with biliary atresia

Cited by 5 publications

References 23 publications

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

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

Prognostic Factors Related to In-hospital Death in Children with Biliary Atresia: Analysis of a Nationwide Inpatient Database

Peri-Operative Liver Fibrosis and Native Liver Survival in Pediatric Patients with Biliary Atresia: A Systematic Review and Meta-Analysis

Contact Info

Product

Resources

About