Biliary Atresia: We Need to Do More!

Abstract

Research Article| October 01 2017 Biliary Atresia: We Need to Do More! AAP Grand Rounds (2017) 38 (4): 40. https://doi.org/10.1542/gr.38-4-40 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Biliary Atresia: We Need to Do More!. AAP Grand Rounds October 2017; 38 (4): 40. https://doi.org/10.1542/gr.38-4-40 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: biliary atresia, portoenterostomy, hepatic Source: Hopkins PC, Yazigi N, Nylund CM. Incidence of biliary atresia and timing of hepatoportoenterostomy in the United States. J Pediatr. 2017; 187: 253– 257; doi: https://doi.org/10.1016/j.jpeds.2017.05.006Google Scholar Investigators at Uniformed Services University of the Health Sciences in Bethesda, MD, and MedStar Georgetown Transplant Institute in Washington, DC, conducted a retrospective cohort study to evaluate the incidence, trends, seasonality, and age at the time of hepatoportoenterostomy (Kasai procedure) for biliary atresia in the United States. Cases were defined as infants aged <1 year who were hospitalized with biliary atresia, as determined by an ICD-9 diagnostic code for biliary atresia and a procedure code for the Kasai surgery during the study period of 1997 through 2012. Cases were identified by using the Healthcare Cost and Utilization Project–Kids’ Inpatient Database (HCUP-KID), which is a nationwide inpatient database in which an individual-level population weight is also assigned to allow for estimation of national case incidences and trends. Race, sex, and national total population data according to age and year were also extracted from the HCUP-KID. Investigators calculated the overall and yearly incidences of biliary atresia by dividing the number of weighted cases by the total number of infants in the United States. Patient age at the time of the Kasai procedure was calculated by using age in days at the time of admission to the hospital. Trends in incidence and age at the time of the Kasai surgery over time were also evaluated, as were differences in incidence according to demographics. Seasonality of biliary atresia was determined by separating the cases of biliary atresia according to month. There were 1,057 weighted cases of biliary atresia identified, resulting in an overall incidence of 4.47 per 100,000 cases. The incidence of biliary atresia was significantly higher in female, Asian or Pacific Islander, and black subjects. There was a significant increase in the incidence of biliary atresia over the study period, from 2.85 per 100,000 in 1997 to 5.55 per 100,000 in 2012 (P < .001). The median age at the time of the Kasai procedure was 63 days. There was no significant change in age at the time of the Kasai surgery over the study period. There was also no significant difference in the number of cases of biliary atresia according to month. The investigators conclude that the incidence of biliary atresia has increased since 1997 and that the median age at the time of the Kasai procedure is outside the optimal window of <60 days that is associated with improved outcomes.1 Dr Rosenthal has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. Biliary atresia remains the leading indication for pediatric liver transplants in the United States.2 In spite of increased awareness of the disorder and the need for early intervention to achieve optimal surgical success and re-establishment of bile flow, the data presented by the investigators... You do not currently have access to this content.