Excellent Outcomes of Biliary Atresia Over the Coronavirus-19 Disease Era in a Tertiary Referral Paediatric Liver Transplant Unit in Singapore

Abstract

Groups from the United Kingdom and Europe observed decreased incidence of biliary atresia (BA) with an increased time to Kasai portoenterostomy (KPE) during the coronavirus disease-19 (COVID-19) pandemic [1, 2]. This was attributed to changes in health behaviours resulting in delayed presentations and decreased sensitivity in detecting jaundice over teleconsultations. In contrast, our experience at the only paediatric liver transplantation (LT) unit in Singapore during the COVID-19 era showed a trend of steady incidence for BA, timely KPE, excellent jaundice clearance of 75% and comparable post-transplantation survival of 85.7%.

A retrospective analysis was conducted of children with BA who underwent KPE during COVID-19 era (2020–2023, Group 1), in comparison with a similar period prior (2016–2019, Group 2) and previously reported historical controls (1989–2015, Group 3) [3] (Table 1).

BA incidence (p = 0.222) and their median age at KPE (p = 0.755) were similar across groups 1 and 2. Suspension of elective operations did not increase the time to KPE as compared to pre-COVID-19 periods. Superior jaundice clearance rate during COVID-19 era did not reach statistical significance as compared to other periods (p = 0.638).

In response to the pandemic, the Singapore Healthcare Corps was formed by the Ministry of Health, recruiting additional clinical and non-clinical manpower to meet the needs of the pandemic, thus enabling specialists to continue delivering essential care [4]. General paediatricians continued to have direct referral access for local resident patients to in-person consultations at our tertiary centre throughout the pandemic, possibly allowing timely assessment and intervention. Essential time-sensitive surgeries were approved on a case-by-case basis, adhering to strict protocols and airborne precautions with personal protective equipment. Suspected or confirmed COVID-19 patients were treated in dedicated isolation wards and negative-pressure operating theatres to minimise exposure to healthcare staff and other patients.

Paediatric LT numbers were lower during COVID-19 period. Organ transplantations were suspended in the early days of COVID-19 due to uncertainties surrounding its safety during a pandemic. As healthcare services gradually reopened, solid organ transplantations were resumed with strict screening protocols, achieving excellent outcomes [5]. One patient developed hepatic artery thrombosis and demised in the immediate post-transplantation period due to factors unrelated to the pandemic. He tested negative for COVID-19 RT-PCR 7 days and 48 h before transplantation and post-transplantation.

Pandemics may continue to occur and influence our health behaviours and protocols. A well-managed healthcare delivery may include continued access and management of time-sensitive conditions during pandemic priorities; thereby allowing for timely intervention and excellent outcomes in children with BA.

The authors declare no conflicts of interest.