Is the Kasai operation still indicated in children older than 3 months diagnosed with biliary atresia?

• Published in: The Journal of pediatrics Vol. 138; no. 2; pp. 224 - 228
• Main Authors: Chardot, Christophe, Carton, Matthieu, Spire-Bendelac, Nathalie, Le Pommelet, Christophe, Golmard, Jean-Louis, Reding, Raymond, Auvert, Bertran
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.02.2001; Elsevier
• Subjects: Age Factors; Biliary Atresia - mortality; Biliary Atresia - surgery; Biological and medical sciences; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Infant; Liver Transplantation; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Malformations; Medical sciences; Portoenterostomy, Hepatic - mortality; Prognosis; Survival Rate; France; Europe; LT; NS; BA; Human; Biliary tract; Enterostomy; Indication; Gut; Infant; Biliary tract disease; Congenital disease; Counter indication; Malformation; Surgery; Atresia; Digestive diseases; Therapeutic protocol; Age
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1067/mpd.2001.111276

Objectives: The prognosis of hepatoportoenterostomy (the Kasai operation) for biliary atresia worsens when the age at surgery increases. This study examines whether the Kasai operation remains justified after 3 months of life. Study Design: Records for all patients with biliary atresia living in France and born in the years 1986 to 1996 were reviewed, and patients were classified into 3 groups: group 1 (n = 30), no contraindication to the Kasai operation, but orientation to de novo transplantation; group 2 (n = 380), age at Kasai operation <90 days; and group 3 (n = 60), age at Kasai operation ≥90 days. Survival with native liver, survival after liver transplantation, and overall survival (Kaplan-Meier method) were compared by using the log-rank test. Results: Five-year (10-year) survival with native liver was 35% (30%) in group 2 and 25% (22%) in group 3 (P =.03). Five-year overall survival was 57%, 74%, and 55% in groups 1, 2, and 3, respectively (P =.003). Poor results in groups 1 and 3 were mainly due to increased pre-transplantation mortality, but survival after transplantation was not significantly different in the 3 groups. Conclusions: Performance of the Kasai operation after 3 months of age is justified in selected cases, because it may obviate liver transplantation. Preoperative evaluation should exclude patients with advanced liver disease for whom liver transplantation should not be delayed. (J Pediatr 2001;138:224-8)