Evaluation of Perioperative Complications in the Management of Biliary Atresia.

Min Du,Yue Tang,Gong Chen,Shan Zheng,Rui Dong,Zhen Shen,Jingying Jiang,Yanlei Huang,Junfeng Wang

doi:10.3389/fped.2020.00460

Abstract

Purpose: To analyze the influence of perioperative complications in the management of biliary atresia (BA).Methods: A retrospective study was performed using a total of 422 BA patients who underwent Kasai portoenterostomy (KPE) in a single institution between February 2016 and May 2017. Data on patients' clinical characteristics, laboratory examinations, perioperative complications, and outcomes were collected. Unpaired two-tailed t-test and χ2 test were employed for the comparison between BA patients with and without perioperative complications. Cox regression analysis was used to screen the risk factors for 2-years NLS in BA, and their influence on the 2-years NLS was analyzed using Kaplan–Meier survival analysis as well as the log-rank test.Results: The incidence of perioperative complications, 6-months jaundice clearance (JC) and 2-years native liver survival (NLS) rate were 60.4, 59.5, and 56.6%, respectively. Patients with perioperative complications had lower serum albumin (ALB) level, but higher aspartate aminotransferase-to-platelet ratio index (APRI) and international normalized ratio (INR) levels when compared with those without perioperative complications (ALB, P < 0.05; APRI, P < 0.01; INR, P < 0.05). Moreover, perioperative complications were correlated with glucocorticoid administration (P = 0.002). Univariate Cox regression analysis showed no relationship between perioperative complications and 2-years NLS (P > 0.05). However, multivariate Cox regression analysis indicated 6-months JC was an independent protective factor for 2-years NLS [P < 0.0001, hazard ratio (HR) = 0.074, 95% confidence interval = 0.05–0.11], and concordance index of this prediction model including age, weight, APRI, glucocorticoid, and 6-months JC was 0.811.Conclusion: Although perioperative complication is common during and after KPE, it had no influence on the prognosis of BA. However, assessment of the serum level of total bilirubin after KPE may serve as an important predictor for the outcome in BA.

Highlights

Biliary atresia (BA) is a life-threatening pediatric hepatobiliary disease that is caused by a progressive inflammatory and fibrotic obliteration of the bile ducts [1]
A total of 239 patients (56.6%) of BA patients survived with native liver; the rest comprised those with liver transplantation (18.7%) and death (24.6%) at 2 years after Kasai portoenterostomy (KPE)
Perioperative complications were correlated with glucocorticoid administration (P = 0.002); less glucocorticoids were administered in the patients with perioperative complications

Summary

Introduction

Biliary atresia (BA) is a life-threatening pediatric hepatobiliary disease that is caused by a progressive inflammatory and fibrotic obliteration of the bile ducts [1]. According to the anatomical structure, the Japanese Society of Pediatric Surgery classified BA into three types, including type I BA (choledochal atresia), type II BA (the common hepatic duct atresia), and type III BA (hepatic portal atresia) [5]. Type III BA was previously considered as the “uncorrectable” type with poor outcomes affecting 80–95% of patients [6, 7]. It was demonstrated that native liver survival (NLS) rates ranged from 20 to 76% at 1–3 years following KPE [10]. Even in cases of successful KPE, complications occur in ∼60% of patients; large cohort studies that focus on the comprehensive perioperative complications of BA are limited [12, 13]. Perioperative complications have previously been defined as complications that occurred during and up to 30 days after surgery [14]. Pressing questions for surgeons to answer are as follows: What are the characteristics of perioperative complications of BA? And what is the impact of perioperative complications on the outcome of BA? This study aimed to characterize perioperative complications of BA and analyze the predictors of prognosis, and the relationship between perioperative complications and prognosis in BA

Objectives

Methods

Results

Conclusion