Abstract
Considering that some biliary atresia (BA) survivors with native liver have reached reproductive age and face long-lasting complications, specific attention needs to be paid to pregnant cases. This study aimed to investigate the relationship between liver function, perinatal outcomes, and prognosis. A database review was conducted to identify pregnant BA cases with native liver and perinatal data, and clinical information on BA-related complications was analyzed. Perinatal serum cholinesterase (ChE) levels, model for end-stage liver-disease (MELD) score, and platelet trends were analyzed, and the association between these indicators and perinatal outcomes was investigated. Patients were categorized into three groups according to the perinatal clinical outcomes: favorable (term babies with or without several episodes of cholangitis; n = 3), borderline (term baby and following liver dysfunction; n = 1), and unfavorable (premature delivery with subsequent liver failure; n = 1). Lower serum ChE levels, lower platelet counts, and higher MELD scores were observed in the unfavorable category. Borderline and unfavorable patients displayed a continuous increase in MELD score, with one eventually needing a liver transplantation. Pregnancy in patients with BA requires special attention. Serum ChE levels, platelet counts, and MELD scores are all important markers for predicting perinatal prognosis.
Highlights
Kasai portoenterostomy has been widely accepted as the primary method of surgical treatment for biliary atresia (BA), and early diagnosis and timely surgery are known to have a significant impact on long-term prognosis [1,2,3]
In pregnant women with native liver after BA surgery, such complications can be exacerbated by pregnancy-associated physiology [6]
Perinatal outcomes after BA surgery were divided into three groups on the basis thereof: favorable, borderline, and unfavorable
Summary
Kasai portoenterostomy has been widely accepted as the primary method of surgical treatment for biliary atresia (BA), and early diagnosis and timely surgery are known to have a significant impact on long-term prognosis [1,2,3]. Some long-term survivors of the Kasai procedure face and suffer from life-long complications, such as portal hypertension and recurrent cholangitis [4,5]. In pregnant women with native liver after BA surgery, such complications can be exacerbated by pregnancy-associated physiology [6]. Among pregnant patients with BA and native liver, both favorable and unfavorable perinatal courses are reported mainly because of complications, and some develop liver failure after pregnancy [6,8,9,10,11]. Sasaki et al [9] revealed that a history of cholangitis and variceal breeding prior to pregnancy led to recurrent complications during pregnancy
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