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Prognostic factors and outcomes of Kasai portoenterostomy (KPE): nine-year experience from a lower-middle income country

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Abstract

Purpose

Outcome data after Kasai portoenterostomy (KPE) reported worldwide show considerable regional and institutional variation. It is not known whether the same standards of outcomes reported in western world can be replicated in resource-poor countries.

Methods

We reviewed 79 patients of which 43 had completed a 2-year minimum follow-up. Two cohorts were based on age at KPE. The median age at surgery was 60 days.

Results

Clearance of jaundice (COJ) at 3 months was 20.93% and was not affected by age at surgery (p = 0.295). Four patients (9.3%) received liver transplant and 16 patients (37.21%) were recorded dead at a median age of 7 months. Native liver survival (NLS) was 53.49% and overall survival (OS) was 62.79%. Kaplan–Meier estimated 4- and 6-year NLS were 55.8% and 49.6%, respectively. There was a significant difference in the NLS between early and late surgery groups.

Conclusion

While causes for low COJ need to be explored, these data reaffirm that early surgery has a significant favorable effect on survival. NLS was comparable with data from the developed world, whereas low OS is explained by limited access to transplant. Thus, where the survival depends on native liver longevity, emphasis should be on as early KPE as possible.

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Data availability

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

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Funding

No funding was received for this study.

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Authors and Affiliations

  1. Lady Ridgeway Hospital for Children, Colombo, Sri Lanka

    Nipun Wickramasekara, Jenosha Ignatius & Ananda Lamahewage

Authors
  1. Nipun Wickramasekara
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  2. Jenosha Ignatius
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  3. Ananda Lamahewage
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Contributions

NW and AL involved in the design and concept of the study. NW and JI were involved in the literature review, writing the project proposal, obtaining ethical approval as well as data collection. JI did the data entry and statistical analysis was done by JI and NW. NW wrote the manuscript. AL contributed with proof reading and overall guidance. All authors read and approved the final manuscript (NW, JI, AL).

Corresponding author

Correspondence to Nipun Wickramasekara.

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Ethical clearance was obtained from Ethical Review Committee, Lady Ridgeway Hospital for Children.

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Wickramasekara, N., Ignatius, J. & Lamahewage, A. Prognostic factors and outcomes of Kasai portoenterostomy (KPE): nine-year experience from a lower-middle income country. Pediatr Surg Int 39, 142 (2023). https://doi.org/10.1007/s00383-023-05424-y

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