A periodic comparison of the survival and prognostic factors of biliary atresia after Kasai portoenterostomy: a single-center study in Korea

Abstract

Purpose

We explored the chronologic changes in prognostic factors and clinical outcomes of Kasai portoenterostomy (KPE) for biliary atresia (BA).

Methods

Patients undergoing KPE between 1997 and 2016 were analyzed retrospectively. Ninety-two consecutive patients who underwent KPE from 1997 to 2006 (Era 1) were compared with 150 patients who underwent KPE from 2007 to 2016 (Era 2) for clinical outcomes and prognostic factors.

Results

The jaundice clearance rate increased by 8.8% (66.7% vs. 75.5% for Eras 1 and 2, respectively, p = 0.180), and the 5-year native liver survival (NLS) rate improved slightly (62.5% vs. 64.0% for Eras 1 and 2, respectively, p = 0.617) in Era 2. The hazard ratio for age at KPE (≥ 90 days) with regard to 5-year NLS and the odds ratio for age at KPE (< 90 days) with regard to jaundice clearance were both lower in Era 2 than in Era 1 (1.95 vs. 2.25 and 2.67 vs. 5.21, respectively).

Conclusion

The clinical outcomes improved over a period in a single surgeon’s practice. We demonstrated that the impact of age at the time of KPE on operative outcomes became less significant over time with the increase in the single surgeon’s experience and improvement in medical treatment for BA.

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Correspondence to Seok Joo Han.

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Conflict of interest

The authors have no conflicts of interest or financial relationships relevant to this article to disclose.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board of Severance Hospital (approval number: 4-2017-1101).

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A waiver of informed consent was granted because the study was determined to be minimal risk and because data are de-identified.

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Ihn, K., Na, Y., Ho, I.G. et al. A periodic comparison of the survival and prognostic factors of biliary atresia after Kasai portoenterostomy: a single-center study in Korea. Pediatr Surg Int 35, 285–292 (2019). https://doi.org/10.1007/s00383-018-04434-5

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Keywords

  • Biliary atresia
  • Kasai portoenterostomy
  • Prognosis
  • Liver fibrosis
  • Native liver survival