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. 2023 Jan 1;76(1):66-71.
doi: 10.1097/MPG.0000000000003638. Epub 2022 Oct 27.

What Makes A "Successful" Kasai Portoenterostomy "Unsuccessful"?

Melania Matcovici  1 , Ionica Stoica, Kristy Smith, Mark Davenport
Affiliations

What Makes A "Successful" Kasai Portoenterostomy "Unsuccessful"?

Melania Matcovici et al. J Pediatr Gastroenterol Nutr. .

Abstract

Objectives: Clearance of jaundice (CoJ) is the first key objective of Kasai portoenterostomy (KPE) for biliary atresia (BA) and its achievement is by far the best index of long-term prognosis. We sought to identify the reasons for failure [subsequent liver transplant (LT)] in this cohort.

Methods: Review of single-center prospective BA database. Successful KPE was defined by achieving a postoperative bilirubin of ≤20 µmol/L. Pre-KPE and post-KPE variables were identified together with a multivariate logistic regression model to identify those observable at 3 months post-KPE. Data are quoted as median (range). A P value of ≤0.05 was significant.

Results: One hundred thirty-five infants underwent KPE between January 2012 and December 2018, of which 90 (67%) achieved CoJ. From these 20 (22%) (Cohort A) underwent LT with the remainder continuing with native liver (Cohort B) (median follow-up of 4.15 years). There was no difference in age at KPE ( P = 0.41), APRi (aspartate aminotransferase-to-platelet ratio) ( P = 0.07), associated anomalies ( P = 0.7), and cytomegalovirus status ( P = 0.7) between the 2 groups. Postoperatively, both cholangitis [any episode, 18/20 (90%) vs 15/70 (21%); P < 0.0001] and portal hypertension (PHT) [gastrointestinal (GI) bleed, 10/20 (50%) vs 2/70 (2.8%); P < 0.0001] were significantly more common in cohort A. Univariate analysis showed that the most significant predictive values at 3 months for LT by 2 years were high APRi, bilirubin, international normalized ratio, and ultrasound (US)-detected ascites with multivariate logistic modeling confirming these variables with predictive values of r2 = 0.79, AUROC = 0.98.

Conclusions: Failure is not preordained at KPE but due to recurrent cholangitis and/or symptoms of PHT.

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Conflict of interest statement

The authors report no conflicts of interest.

Comment in

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