Revisiting long-term prognostic factors of biliary atresia: A 20-year experience with 81 patients from a single center

Short- and long-term outcomes after Kasai operation for type III biliary atresia: Twenty years of experience in a single tertiary Egyptian center-A retrospective cohort study

“…access to medical care, diagnosis efficiency, surgery scheduling, etc) on post-operative jaundice resolution, short-, mid-and long-term both NLS and overall survivals has been a matter of debate for years in the literature as some reports have been against its benefit, while most others have ensured its importance [ 60 ]; those ensuring studies have documented that the operation has had better outcomes when has been performed before 90 days of life due to the presence of an association between younger age at KPE and both increased porta-hepatis remnant ducts NO and decreased fibrosis grade [ 8 , 61 , 62 ]; therefore, performing it before 90 days has been the goal of most centers. Similarly, and despite the need for more improvement, only 23% of our infants underwent the operation after 90 days of life as we did our best for early detection of the disease, moreover, age<90 days at KPE was a significant predictor of postoperative jaundice resolution and independent predictor of long-term NLS in our study, also, younger age at KPE was a significant predictor of jaundice resolution in Chardot et al, 2013 [ 13 ], Pakarinen et al, 2018 [ 20 ], Parolini et al, 2019 [ 22 ], Hanalioğlu et al, 2019 [ 27 ], and Ihn et al, 2018 [ 63 ] retrospective studies. Moreover, it was an independent predictor of 4- and 5-year TFS in de Vries et al, 2012 [ 15 ] and Qiao et al, 2015 [ 64 ] retrospective studies respectively.…”

“…Moreover, it was an independent predictor of 4- and 5-year TFS in de Vries et al, 2012 [ 15 ] and Qiao et al, 2015 [ 64 ] retrospective studies respectively. Furthermore, it had a significant association with short- and long-term TFS outcomes in Zhen et al, 2015 [ 9 ], Chardot et al, 2013 [ 13 ], Pakarinen et al, 2018 [ 20 ], Hanalioğlu et al, 2019 [ 27 ], and Nightingale et al, 2017 [ 46 ] studies. On the other hand, it was not a predictor of jaundice resolution in Webb et al, 2017 [ 11 ], Sookpotarom et al, 2006 [ 59 ] , or Yassin et al, 2020 [ 65 ] retrospective studies, also, it was not associated with short- or long-term TFS outcomes in Webb et al, 2017 [ 11 ], Jain et al, 2019 [ 21 ], Koga et al, 2013 [ 38 ], Chung et al, 2015 [ 51 ], Ramos-Gonzalez et al, 2019 [ 58 ], Ihn et al, 2018 [ 63 ], Nio et al, 2010 [ 66 ], Sasaki et al, 2016 [ 67 ], Chiang et al, 2017 [ 68 ], Nio et al, 2018 [ 69 ] or Wildhaber et al, 2003 [ 70 ] retrospective or prospective studies.…”

“…Preoperative lower mean DB and AST were independent predictors of Post KPE jaundice clearance and significant predictors of good NLS in our work; similarly, lower preoperative median AST had a significant correlation with jaundice resolution in Yassin et al, 2020 [ 65 ] retrospective study, also, Preoperative lower mean DB and AST had a trend towards significant correlation with SNL in Goda et al, 2013 [ 73 ] retrospective study. The preoperative INR value reflects the secretory/synthetic liver function affecting the long-term postoperative outcomes [ 27 ]. Similarly, preoperative INR was a predictor of both jaundice clearance and long-term NLS in our work.…”

“…age at surgery, surgical center and surgeon experience, liver fibrosis degree, presence and size of bile ductules at the portal plate, associated anomalies, anatomical type of BA, international normalization ratio(INR), etc) as well as postoperative parameters (i.e. using a steroid, antibiotic and/or ursodeoxycholic acid (UDCA), jaundice clearance, the occurrence of cholangitis/PHN, intrahepatic biliary cyst formation, etc) [ [8] , [9] , [10] , [26] , [27] , [28] ]. Finally, as there is scanty literature on the long-term (20-year) outcome and its predictors after KPE for type III BA, our work aimed to analyze this important issue besides analyzing short-term outcome and its predictors in a tertiary Egyptian hepato-pancreato-biliary(HPB) center.…”

Biological and Histological Assessment of the Hepatoportoenterostomy Role in Biliary Atresia as a Stand-Alone Procedure or as a Bridge toward Liver Transplantation

“…Of the remaining four patients that underwent surgery after 60 days of age, only one survived, with liver transplantation, performed three months after HPE, while for the others the death occurred through pulmonary or cirrhosis complications. Data from the literature showed that at an age of 60–90 days, the biliary drainage is efficient in 40–50% of cases, while over 90 days, this rate drops to 25% and at less than 20% when surgery is performed over 100 days [ 13 ]. When surgery is performed at 121–150 days of life biliary drainage occurs only in 7.7% of patients [ 7 ].…”