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Prognostic values of serum bilirubin at 7th day post-Kasai for survival with native livers in patients with biliary atresia

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Abstract

Background

Biliary atresia (BA) is a serious liver disease with uncertain prognosis. The objective of this study was to investigate prognostic values of the >20 % decrease in serum total bilirubin (TB) at 7th day post-op regarding early outcome and 5-year survival with native liver in BA.

Methods

Biliary atresia patients undergoing Kasai operation between 2000 and 2014 were reviewed. The ratio of serum TB at 7th day post-op to pre-op TB levels (TB7/TB0) was calculated for every patient. TB7/TB0 ratio of <0.8 indicated the >20 % decrease in serum TB. At 6th month following Kasai operation, outcome of BA patients were categorized into good outcome (TB < 2 mg % or clinically jaundice free) and poor outcome (TB > 2 mg % or clinically jaundice). For outcome analysis, logistic regression was used. For survival analysis, Cox regression was applied.

Results

There were 133 BA patients (M:F = 68:65) undergoing Kasai operation. Median age at surgery was 79 days. BA patients with TB7/TB0 ratio of <0.8 were found in 38 %. Outcome at 6-month post-op could be evaluated in 126 patients (good: poor = 68:58). The 1-, 3- and 5-year survival rates with native livers were 85, 70 and 65 %, respectively. The median overall survival with native livers was 164 months. Median follow-up time was 87 months. Logistic regression showed that gender and age at operation were not significant factors impacting on early outcome (p > 0.05). However, TB7/TB0 ratio of <0.8 was an independent factor for good outcome (Odds ratio = 3.0, p = 0.006). Cox regression analysis demonstrated that 5-year survival rate was significantly correlated with TB7/TB0 ratio of <0.8 (HR = 0.46, 95 % CI 0.23–0.91, p = 0.025) and outcome at 6th month post-op (HR = 0.05, 95 % CI 0.01–0.15, p < 0.001).

Conclusions

The >20 % decrease in serum TB at 7th day post-Kasai is a predictor for good outcome. BA patients with TB7/TB0 of <0.8 had 5-year survival with native livers significantly higher than those with the ratio of >0.8.

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Authors and Affiliations

  1. Department of Surgery, Faculty of Medicine, Chulalongkorn University, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Rama IV road, Patumwan, Bangkok, 10330, Thailand

    Sinobol Chusilp, Paiboon Sookpotarom, Kanokan Tepmalai, Prapapan Rajatapiti & Paisarn Vejchapipat

  2. Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand

    Sinobol Chusilp

  3. Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, Thailand

    Paiboon Sookpotarom

  4. Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Kanokan Tepmalai

  5. Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand

    Voranush Chongsrisawat & Yong Poovorawan

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  1. Sinobol Chusilp
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  2. Paiboon Sookpotarom
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  3. Kanokan Tepmalai
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  6. Yong Poovorawan
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  7. Paisarn Vejchapipat
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Correspondence to Paisarn Vejchapipat.

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Chusilp, S., Sookpotarom, P., Tepmalai, K. et al. Prognostic values of serum bilirubin at 7th day post-Kasai for survival with native livers in patients with biliary atresia. Pediatr Surg Int 32, 927–931 (2016). https://doi.org/10.1007/s00383-016-3951-9

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  • DOI: https://doi.org/10.1007/s00383-016-3951-9

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