Multicenter Study

. 2022 Feb;38(2):193-199.

doi: 10.1007/s00383-021-05047-1. Epub 2021 Dec 2.

The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

Lorraine I Kelley-Quon^{1

2}, Eveline Shue³, Rita V Burke⁴, Caitlin Smith⁵, Karen Kling⁶, Elaa Mahdi³, Shadassa Ourshalimian³, Michael Fenlon³, Matthew Dellinger⁵, Stephen B Shew⁷, Justin Lee⁸, Benjamin Padilla⁸, Thomas Inge⁹, Jonathan Roach⁹, Ahmed I Marwan⁹, Katie W Russell¹⁰, Romeo Ignacio⁶, Elizabeth Fialkowski¹¹, Amar Nijagal¹², Cecilia Im¹², Kenneth S Azarow¹¹, Daniel J Ostlie⁸, Kasper Wang³

Affiliations

¹ Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #100, Los Angeles, CA, 90027, USA. lkquon@chla.usc.edu.
² Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. lkquon@chla.usc.edu.
³ Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #100, Los Angeles, CA, 90027, USA.
⁴ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁵ Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
⁶ Department of Pediatric Surgery, Rady Children's Hospital San Diego, University of California School of Medicine, San Diego, CA, USA.
⁷ Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
⁸ Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
⁹ Department of Surgery, University of Colorado Denver School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA.
¹⁰ Division of Pediatric Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA.
¹¹ Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
¹² Division of Pediatric Surgery, University of California, San Francisco, CA, USA.

PMID: 34854975
PMCID: PMC8742784
DOI: 10.1007/s00383-021-05047-1

Multicenter Study

The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

Lorraine I Kelley-Quon et al. Pediatr Surg Int. 2022 Feb.

. 2022 Feb;38(2):193-199.

doi: 10.1007/s00383-021-05047-1. Epub 2021 Dec 2.

Authors

Affiliations

¹ Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #100, Los Angeles, CA, 90027, USA. lkquon@chla.usc.edu.
² Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. lkquon@chla.usc.edu.
³ Division of Pediatric Surgery, Children's Hospital Los Angeles and the Keck School of Medicine, University of Southern California, 4650 Sunset Blvd. MS #100, Los Angeles, CA, 90027, USA.
⁴ Department of Population and Public Health Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁵ Division of Pediatric General and Thoracic Surgery, Department of Surgery, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA.
⁶ Department of Pediatric Surgery, Rady Children's Hospital San Diego, University of California School of Medicine, San Diego, CA, USA.
⁷ Division of Pediatric Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA, USA.
⁸ Division of Surgery, Phoenix Children's Hospital, Phoenix, AZ, USA.
⁹ Department of Surgery, University of Colorado Denver School of Medicine and Children's Hospital of Colorado, Aurora, CO, USA.
¹⁰ Division of Pediatric Surgery, University of Utah and Primary Children's Hospital, Salt Lake City, UT, USA.
¹¹ Division of Pediatric Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR, USA.
¹² Division of Pediatric Surgery, University of California, San Francisco, CA, USA.

PMID: 34854975
PMCID: PMC8742784
DOI: 10.1007/s00383-021-05047-1

Abstract

Purpose: The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia.

Methods: A multi-institutional, retrospective cohort study was performed at nine tertiary-level children's hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance.

Results: Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3 months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97-0.99).

Conclusion: Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.

Keywords: Biliary atresia; Kasai portoenterostomy; Liver transplant; Transplant-free survival.

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Figures

**Figure 1.**
Predicted probabilities of Transplant-free Survival (TFS) by Age at Time of Kasai Portoenterostomy.

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The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

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The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

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