Identification of clinical and laboratory factors predictive of long term-native liver survival after Kasai portoenterostomy

Abstract

Purpose

This study explored pre- and post-operative predictive factors for long-term native liver survival (NLS) in patients with biliary atresia (BA) after Kasai hepatoportoenterostomy (KPE).

Methods

We retrospectively reviewed 50 consecutive patients with BA between January 1990 and December 2023 at our institute after excluding those with splenic malformations. We analyzed the prognostic factors at pre-KPE, 30 days and 6 months after KPE for a long-term NLS.

Results

Of the 50 patients, 25 survived with their native liver, and 25 showed native liver failure over a median 109 (2–395) months. A multivariable analysis showed that early age (≤56 days old) at KPE was a predictive factor for an NLS (odds ratio [OR]: 5.43, 95 % confidence interval [CI] 1.04–28.30; p = 0.045). Serum total bilirubin (≤3.5 mg/dl) at 30 days (OR: 9.31, 95 % CI 1.57–55.07; p = 0.014) and bile acid (≤49.6 nmol/ml) at 6 months after KPE were predictive factors for an NLS (OR: 35.33, 95 % CI 1.82–686.03; p = 0.019).

Conclusion

KPE for BA should be performed early (≤56 days old) for an NLS. Serum total bilirubin ≤3.5 mg/dl at 30 days and bile acid ≤49.6 nmol/ml at 6 months after KPE were predictive factors for an NLS.