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Review
. 2023 Dec 31;15(12):e51424.
doi: 10.7759/cureus.51424. eCollection 2023 Dec.

Are the Post-transplant Outcomes of Kasai's Early Failure and Late Failure Comparable to the Primary Liver Transplantation?

Valberto Sanha  1 , Tales A Franzini  2 , Waldemir F Junior  3 , Antonio N Kalil  4
Affiliations
Review

Are the Post-transplant Outcomes of Kasai's Early Failure and Late Failure Comparable to the Primary Liver Transplantation?

Valberto Sanha et al. Cureus. .

Erratum in

Abstract

It is uncertain whether prior Kasai procedures negatively impact the outcomes of liver transplantation (LT). The prior meta-analysis did not distinguish between Kasai early failure (K-EF) and late failure (K-LF). Numerous studies have been recently published; therefore, we perform a systematic review and meta-analysis. We searched PubMed and Embase databases to identify studies comparing the outcomes of biliary atresia (BA) patients undergoing primary LT versus patients with prior Kasai procedures. Subgroup analysis was done at the time of Kasai failure (early vs. late). Twenty-five studies comprising 6,408 patients receiving LT were included in the analysis. We found a statistically significant increase in one-year graft survival in K-LF versus primary liver transplant (pLT) (P = 0.0003). One-year patient survival was also increased in K-LF, although not statistically significant (P = 0.09). No difference in the one- and five-year graft and patient survival, reoperation rate, infection, and biliary complication was seen in pLT vs overall prior Kasai (K-EF and K-LF). These results suggest that prior kasai procedure does not negatively impact the outcome of LT. In addition, BA patients with prior Kasai undergoing LT later in life tend to perform better than primary liver transplants.

Keywords: biliary atresia; kasai hepatico-portoenterostomy; kasai procedure; pediatric liver transplant; primary liver transplantation.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. PRISMA flow diagram
Figure 2
Figure 2. One-year patient survival rate: pLT vs. prior Kasai
pLT - primary liver transplant, LT - liver transplant
Figure 3
Figure 3. One-year graft survival rate: pLT vs. prior Kasai
pLT - primary liver transplant, LT - Liver transplantation
Figure 4
Figure 4. Reoperation rate: pLT vs. prior Kasai
pLT - primary liver transplant, LT - Liver transplantation
Figure 5
Figure 5. (A) Biliary complication rate: pLT vs. Prior Kasai. (B) Infection rate: pLT vs. prior Kasai
Figure 6
Figure 6. (A) One-year graft survival: pLT vs. K-LF. (B) One-year patient survival: pLT vs. K-LF
pLT - primary liver transplant, K-LF - Kasai late failure
Figure 7
Figure 7. Funnel analysis on reoperation
Figure 8
Figure 8. Supplemental Appendix
(E) One-year patient survival rate: pLT vs. Kasai late failure (K-EF). (F) One-year graft survival rate: pLT vs. Kasai late failure (K-EF).
Figure 9
Figure 9. Supplemental Appendix
(A) Five-year patient survival rate: pLT vs. prior Kasai. (B) Five-year graft survival rate: pLT vs. prior Kasai.
Figure 10
Figure 10. Supplemental Appendix
(C) Reoperation rate: pLT vs. Kasai late failure (K-LF). (D) Biliary complication rate: pLT vs. Kasai late failure (K-LF).
See this image and copyright information in PMC

References

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