Abstract
BackgroundCholangitis may affect liver failure of biliary atresia (BA) patients after Kasai portoenterostomy (KP). We examined whether the number of cholangitis episodes could be a prognostic marker for liver transplant (LT) in children with BA after Kasai portoenterostomy (KP).MethodsData for BA patients born after 1998 and undergoing KP were obtained from National Health Insurance Research Database (NHIRD), Taiwan. Patients were followed up until the end of 2011. Incidence and the number of cholangitis episodes were recorded and compared between patients based on LT status.ResultsNinety-six (26.8%) of the 366 BA patients underwent LT. More patients who underwent KP at < 60 days of age survived with their native liver (P = 0.007). The mean age at first cholangitis was 0.9 years and 0.8 years in the LT and non-LT groups, respectively (P = 0.868). The cumulative incidence of cholangitis within 2 years after KP did not differ between the groups (hazard ratio 1.2; 95% CI 0.9–1.6). However, the total number of cholangitis episodes was higher in the LT group within 2 years after KP (P < 0.001).ConclusionsCholangitis occurrence was not related to LT in the first 2 years after KP in BA patients, but the number of cholangitis episodes could be a prognostic marker for future LT.
Highlights
Cholangitis may affect liver failure of biliary atresia (BA) patients after Kasai portoenterostomy (KP)
We further evaluated whether the number of cholangitis episodes could be used as a prognostic marker to predict further liver transplant (LT) in BA patients after KP
According to a study of a Japanese population, about 40% of BA patients still required LT within 5 years after KP [9] A few reports have shown that jaundice-free period, cholangitis, and age at the time of KP are associated with LT and late-presenting liver failure referred as patients who survive with their native liver more than 20 years [14, 15, 23] In the present study, BA patients who underwent KP before 60 days of age had a favorable outcome, which is consistent with the findings of previous reports [4, 23,24,25]
Summary
Cholangitis may affect liver failure of biliary atresia (BA) patients after Kasai portoenterostomy (KP). Several risk factors, such as the jaundice-free period and occurrence of cholangitis, as well as age at the time of KP, are predictive of liver failure in BA patients after KP. Among these variables, cholangitis is one of the most commonly seen complications in BA patients after KP, and affects more than 50% of patients despite the use of treatment strategies employing corticosteroid and prophylactic antibiotics after the operation [12,13,14]. The aim of the study was to evaluate whether the number of
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