The need for early Kasai portoenterostomy: a Western Pediatric Surgery Research Consortium study

Lorraine I. Kelley-Quon, Eveline Shue, Rita V. Burke, Caitlin Smith, Karen Kling, Elaa Mahdi, Shadassa Ourshalimian, Michael Fenlon, Matthew Dellinger, Stephen B. Shew, Justin Lee, Benjamin Padilla, Thomas Inge, Jonathan Roach, Ahmed I. Marwan, Katie W. Russell, Romeo Ignacio, Elizabeth Fialkowski, Amar Nijagal, Cecilia ImKenneth S. Azarow, Daniel J. Ostlie, Kasper Wang

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)193-199
Number of pages7
JournalPediatric Surgery International
Issue number2
StatePublished - Feb 2022


  • Biliary atresia
  • Kasai portoenterostomy
  • Liver transplant
  • Transplant-free survival

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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