Impact of age at Kasai operation on short- and mid-term outcomes of biliary atresia at a single institution

Abstract

Objective To analyze the impact of age at Kasai operation on the short- and mid term outcome and the prognostic factors for biliary atresia (BA).Methods Records of 152 patientswith BA who were operated on in our unit between October 2005 and September 2010 were reviewed.Out of the 152 patients,68 were males and 84 were female,the mean age at Kasai operation was 82.3645.17 d with a range of 31 to 528 d,all the patients were regularly followed up except 3 perioperative death,the follow-up time ranged between 2 and 62 months (average,20.11 ± 16.11 m).The KaplanMeier,Cox regression and x2 test were used to analyze the clearance of jaundice,survival rate and prognostic factors.Results The total jaundice disappearance rate was 50％,no significant difference was found among type Ⅰ,Ⅱ and Ⅲ.The jaundice disappearance rates of patients underwent Kasai operation at age ≤60 d,60-≤90 d and 91-120 d were 54％,53％ and 46％,respectively.When the operative age was ≥120 d,the jaundice disappearance rates dropped to 25％,which was dramatically lower.The rate of cholangitis was 57％,and the cholangitis had a significant impact on the jaundice disappearance rates (P＜0.01).The 2,4-year postoperative native liver survival rates were 56％ and 49％,respectively.The 2-year native liver survival rate of patients with cholangitis was 43％,which was dramatically less than that of 77％ in patients without cholangitis.Conclusions Kasai operation is the primary therapy for children with BA,age at operation and type of BA are not related to the short-outcome of Kasai operation,cholangitis is a prognostic impact factor for biliary atresia. Key words: Biliary atresia; Jaundice; Cholangitis; Survival rate