TY - JOUR
T1 - The need for early Kasai portoenterostomy
T2 - a Western Pediatric Surgery Research Consortium study
AU - Kelley-Quon, Lorraine I.
AU - Shue, Eveline
AU - Burke, Rita V.
AU - Smith, Caitlin
AU - Kling, Karen
AU - Mahdi, Elaa
AU - Ourshalimian, Shadassa
AU - Fenlon, Michael
AU - Dellinger, Matthew
AU - Shew, Stephen B.
AU - Lee, Justin
AU - Padilla, Benjamin
AU - Inge, Thomas
AU - Roach, Jonathan
AU - Marwan, Ahmed I.
AU - Russell, Katie W.
AU - Ignacio, Romeo
AU - Fialkowski, Elizabeth
AU - Nijagal, Amar
AU - Im, Cecilia
AU - Azarow, Kenneth S.
AU - Ostlie, Daniel J.
AU - Wang, Kasper
N1 - Funding Information:
Dr. Kelley-Quon is supported by grant KL2TR001854 from the National Center for Advancing Translational Science (NCATS) of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The remaining authors have no relevant financial or non-financial interests to disclose.
Publisher Copyright:
© 2021, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.
PY - 2022/2
Y1 - 2022/2
N2 - Purpose: The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia. Methods: A multi-institutional, retrospective cohort study was performed at nine tertiary-level children’s hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance. Results: Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3 months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97–0.99). Conclusion: Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.
AB - Purpose: The purpose of this study was to investigate factors impacting transplant-free survival among infants with biliary atresia. Methods: A multi-institutional, retrospective cohort study was performed at nine tertiary-level children’s hospitals in the United States. Infants who underwent Kasai portoenterostomy (KP) from January 2009 to May 2017 were identified. Clinical characteristics included age at time of KP, steroid use, surgical approach, liver pathology, and surgeon experience. Likelihood of transplant-free survival (TFS) was evaluated using logistic regression, adjusting for patient and surgeon-level factors. Secondary outcomes at 1 year included readmission, cholangitis, reoperation, mortality, and biliary clearance. Results: Overall, 223 infants underwent KP, and 91 (40.8%) survived with their native liver. Mean age at surgery was 63.9 days (± 24.7 days). At 1 year, 78.5% experienced readmission, 56.9% developed cholangitis, 3.8% had a surgical revision, and 5 died. Biliary clearance at 3 months was achieved in 76.6%. Controlling for patient and surgeon-level factors, each additional day of age toward operation was associated with a 2% decrease in likelihood of TFS (OR 0.98, 95% CI 0.97–0.99). Conclusion: Earlier surgical intervention by Kasai portoenterostomy at tertiary-level centers significantly increases likelihood for TFS. Policy-level interventions to facilitate early screening and surgical referral for infants with biliary atresia are warranted to improve outcomes.
KW - Biliary atresia
KW - Kasai portoenterostomy
KW - Liver transplant
KW - Transplant-free survival
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U2 - 10.1007/s00383-021-05047-1
DO - 10.1007/s00383-021-05047-1
M3 - Article
C2 - 34854975
AN - SCOPUS:85120402049
SN - 0179-0358
VL - 38
SP - 193
EP - 199
JO - Pediatric Surgery International
JF - Pediatric Surgery International
IS - 2
ER -